City Government of Dipolog

City Government of Dipolog

City Government of Dipolog

EMPLOYEE/S PASS SLIP

EMPLOYEE/S PASS SLIP

EMPLOYEE/S PASS SLIP

Date: _____________
Nature: __/___ Official _____ Personal

Date: _______________
Nature: __/___ Official _____ Personal

Date: _______________
Nature: __/___ Official _____ Personal

Destination: ______________________________

Destination: _______________________________

Destination: _______________________________

Reason/s: ________________________________

Reason/s: _________________________________

Reason/s: _________________________________

Estimated No. of Hours/Minutes Consumed:

Estimated No. of Hours/Minutes Consumed:

TIME OUT
__________

Estimated No. of Hours/Minutes Consumed:

TIME IN
__________

TOTAL
__________

TIME OUT
__________

__________________________________________
Name & Signature of Requesting Employee

__________________________________________
Position / Department

Noted:

TIME IN
__________

ATTY. LIZA JANE B. ESTAO

TIME IN
__________

__________________________________________
Name & Signature of Requesting Employee

__________________________________________
Position / Department

__________________________________________
Position / Department

Noted:

ATTY. LIZA JANE B. ESTAO

ATTY. LIZA JANE B. ESTAO

Department Head / Chief of Office

Department Head / Chief of Office

Approved/Disapproved:

Approved/Disapproved:

Approved/Disapproved:

Hon. EVELYN T. UY

Hon. EVELYN T. UY

Hon. EVELYN T. UY

City Mayor/Authorized Representative

City Mayor/Authorized Representative

City Mayor/Authorized Representative

ACTUAL TIME:

ACTUAL TIME:

ACTUAL TIME:
TIME OUT

TIME IN

__________

__________

TOTAL
TIME OUT

TIME IN

__________

__________

TOTAL

_________
__________

TIME OUT

TIME IN

__________

__________

Confirmed by:

______________________________

Personnel Monitoring Committee Member

Personnel Monitoring Committee Member

Note: (Accomplished in Triplicate)
1.
HRMO
2.
City Administrator
3.
PISAC

__________

______________________________

______________________________

Personnel Monitoring Committee Member

TOTAL

Confirmed by:

Confirmed by:

Note: (Accomplished in Triplicate)

1.
HRMO
2.
City Administrator
3.
PISAC

TOTAL
__________

__________________________________________
Name & Signature of Requesting Employee

Noted:

Department Head / Chief of Office

TIME OUT
__________

TOTAL
__________

Note: (Accomplished in Triplicate)

1.
HRMO
2.
City Administrator
3.
PISAC