CS FORM 2015

REQUEST FOR PERMISSION TO TEACH

The Honorable
The Department of Education
Manila
Through Channels

Sir:
In compliance with CSC #5, s. 1996. I have to request to teach after office hours. In this
connection, I am submitting the following data or information about myself.
1. Name: _____________________________ Civil Status: _______________
2. Position: ___________________________ Actual Salary: _____________
3. Ministry/Bureau/Office Where Employed: ___________________________________________
4. Nature of Duties: _____________________________
5. Performance Rating for the Rating Period: _____________________________
6. Educational Qualifications:
College/University Degree Pursued / Finish
__________________________________________ ____________________________
__________________________________________ ____________________________
__________________________________________ ____________________________
7. Other Special Trainings: __________________________________________
8. Nature of Teaching/ Job: __________________________________________
College/University Subjecct to be Taught Unit Specific Time & Day
________________________ _______________________ __________ ________________________
_
________________________ _______________________ __________ ________________________
_
________________________ _______________________ __________ ________________________
_
TOTAL _________

____________________________ ____________________________
(Date) (Signature)

Copy Furnished:
The Honorable, the Chairman
Civil Service Commission
Quezon City RECOMMENDING APPROVAL:
FOR THE DEPARTMENT OF EDUCATION

JEANELYN A. ALEMAN, ED.D.CESO VI

Schools Division Superintendent