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Department of Education
REGION XI – DAVAO REGION
SCHOOLS DIVISION OF DAVAO CITY
SIMON NATIONAL HIGH SCHOOL
PUROK 3, CAWAYAN, CALINAN, DAVAO CITY
Date: _________________
To: THE SCHOOLS DIVISION SUPERINTENDENT
__________________________________
Employee’s Signature over Printed Name
Action Taken:
Attested to employee’s 1 st / 2nd time within the
Presence in the office on semester excused
the said date/time ____ times within this
Semester and subject to
Reason cited found valid,
Notary Public: