APPLICATION FOR PERMIT TO TEACH PART-TIME

Date

JESNAR DEMS S. TORRES, PhD, CESO VI

Assistant Schools Division Superintendent
Officer-in-Charge
Office of the Schools Division Superintendent
Schools Division of Gingoog City

Dear Sir:

I ________________________________________, _________________________, in conformity to the

provisions
(Name) (Position)
of Memorandum Circular No. 17, 1986, would like to kindly request permission to teach part-time
at _______________________________________________________________.
(Name and address of school)

Please find hereunder other details of this application:

Applicant’s Assignment:
School: __________________________
District: _________________________

Latest Performance Rating: _____________

( ) 1st Semester ( ) 2nd Semester ( ) Trimester ( ) Summer SY 20__-__

SUBJECTS UNITS DAY TIME

Name and Signature of Teacher

CERTIFICATION

This CERTIFIES that the above –mentioned DepEd employee named

________________________________ is given the above teaching loads with ___________________________.
(Name of School)

This further CERTIFIES that he/she is only a part-time instructor of this school and the
undersigned is cognizant that he/she is primarily connected with DepEd Division of Gingoog City.

___________________________
Dean/School Admin

Recommending Approval: Approved:

___________________________________ JESNAR DEMS S. TORRES, PhD, CESO VI

Name and Signature of School Head Assistant Schools Division Superintendent
Officer-in-Charge
Office of the Schools Division Superintendent