(To be submitted to the Division Office in 3 copies)

Republic of the Philippines

Department of Education
Region III-Central Luzon
SCHOOLS DIVISION OFFICE OF BULACAN
Capitol Compound, City of Malolos, Bulacan

APPLICATION FOR PERMISSION TO TEACH

OUTSIDE OF OFFICIAL TIME

Name of Applicant: ___________________ Position: ______________________

Highest Educational Attainment: ____________________ Specialization: _____________________
Official Station: ________________________________ Appointment Status: _____________
Office Address: _________________________________________________________________
Performance Ratings for the last 3 years: __; __; (Please see attached)
Length of Service: Signature: ____________________

College/University the Applicant Intends to Teach:

Name:__________ ____________
Address: ______ ______________________________
Term (pls. check) ______ 1st Sem. ______ 2nd Sem. ______ Summer School Year : _____

Subject/s to be taught
Subject/s Time Day Number of Units
_____________________ ___________________ .____________ _________
_ ____________________ ___________________ _____________ ______________
_________________________ ___________________ _____________ ______________
________________________ ___________________ _____________ ______________
Certified Correct:
______________
Director

Regular Teaching Load at the Public School

Subject/s Time Day Number of Units

Please see the attached paper

_________________________________________
(Signature over printed Name of the Principal)

I HEREBY CERTIFY that I have examined __________________________ and found him/her to be

physically fit to carry out additional work beyond the official time of his/her regular function as shown in the
above schedules of work.
_________________________________________
(Signature over printed Name of the Physician )
Address: ________________________ Licensed No.__________________ Date: ____________

Recommending Approval:

MINA GRACIA L. ACOSTA

Asst. Schools Divisions Superintendent

Approved:

ROMEO M. ALIP, Ph.D., CESO V

Date: ________________________ Schools Division Superintendent