Per-Qf-12 Special Order For Return To Duty

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Document Code: SDO-QF-SDOP-PER-12

Quality Form Revision: 00

Effectivity date: 05-25-2018


Name of Office:
SPECIAL ORDER FOR RETURN TO DUTY SDOP-PER

Date:__________________

SPECIAL ORDER ________________

The Return to Duty of ___________________ effective ____________ is hereby approved and made on
official record. Her/his pertinent data are:

Employee Number: _________________________


Position: _________________________
Status: _________________________
Station: _________________________
Division /Station Code: _________________________
Salary Rate: _________________________
Inclusive Period of Absence: _________________________
Nature of Leave: _________________________

Certified Correct:

________________________
School Head

Recommending Approval:

JOVITA G. DIZON
Administrative Officer V

APPROVED:

ESTRELITA S. CUNANAN, Ed. D.


Officer In-Charge
Office of the Schools Division Superintendent

QM - Page 1 of 1

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