GENERAL DIRECTORATE OF HUMAN MANAGEMENT

LICENSE REPORT FORM AND PERMIT REQUEST

GENERAL DATA
Identification card (*): Request Date (*):

Names and surnames: Post:

Dependence: Phone:

APPLICATION DATA
License Permission
Without salary enjoyment Direct Family Death
(They must present evidence no later than 72 hours later)
Marriage
(They must present evidence no later than 72 hours after the license) Birth of Children (Father)
For studies Legal requirement
(It must be requested 60 days in advance and will be evaluated by an
ad-hoc commission) Study
Immediate Family Care Others (specify): _______________________
For sickness
Pre and Post Natal
Other (Specify): ________________________

Duration (*):
_______Days) _______Months years)

Start Date: __________________________________________ End Date: _____________________________________

Comment:

Signature of the Interested Party Signature of the Immediate Superior

Note: fields marked with (*) are required

All requests must be justified, and have the approval of your immediate superior.
Sick leave and pre- and post-natal leave require an original and a copy.
To travel during your vacation time it is not necessary to request licenses or permits.

Av. Máximo Gómez No. 2, DN, Rep. Dom Tel 809-688-9700. www.ministeriodeeducacion.gob.do