Pass Slip Sample
Pass Slip Sample
Pass Slip Sample
Date:________________ Date:________________
Permission is requested to leave the Municipal Permission is requested to leave the Municipal
Hall Premises during office hours. Hall Premises during office hours.
Reasons:_____________________________________ Reasons:_____________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
_________________________ _________________________
Employees Signature Employees Signature
Above Printed Name Above Printed Name
No Objections: No Objections:
________________________ ________________________
Department Head Department Head
Signature Above Printed Name Signature Above Printed Name
Approved: Approved:
_______________________ _______________________
Officer on Duty Officer on Duty
REPUBLIC OF THE PHILIPPINES
Municipality of Alfonso
Alfonso, Cavite
PASS SLIP
Date: _______________
Reasons: ____________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
______________________________
Employees Signature
Above Printed Name
No Objections:
______________________________
Department Head
Signature Above Printed Name
Approved:
MYLENE V. QUILALA
OIC-Human Resource Management Officer III
________________________________________________________________________________________________________________________________
(To be filled up by Security Guard on Duty)
Time of Departure:_______________
Time of Arrival:_______________
______________________________
Officer on Duty