LEARNING & DEVELOPMENT ACTIVITY LEARNER REQUEST AND CONFIRMATION (LDALRC)
(PAXCON)
(for Non-Formal L&D Activities)
Instructions: This confirmation form is to be accomplished by the Learner, approved by the Immediate Superior or Department/Unit Head and sent to the Program Administrator (PA) or Secretariat (Sec) within 48 hours upon receipt of the form.
L&D Activity Title: L&D Activity Date/s & Time:
L&D Type: [ ] Workshop/Training [ ] Seminar/ Symposium [ ] Post-Grad Course [ ] Lectures [ ] Orientation [ ] Others:
TARGET COMPETENCY/VALUE CATEGORY: [ ] Core [ ] Organizational [ ] Leadership [/] Technical [ ]Others
TARGET COMPETENCY/VALUE NAME/S: Target Competencies/Values: Government and Departmental
Policies and Procedures, Continuous Development, Effective Communication Skills, Technical Writing
Learning Service Provider/s (LSP/s): Venue:
Program Administrator (PA): Program Secretariat (Sec):
Attending the If YES (attending the L&D Activity)
Suffix Activity
No. Complete Name (Last, First, M.I.) Sex (i.e. Position/Designation Signature & Date
M/F Dr., RN,
etc., N/A) Reliever Contact No. E-mail Add Food Restrictions/
YES NO (If applicable) Comments
1
2
3
4
5
* Please attach an additional sheet or insert rows if necessary.
NOTE: Attendance shall be on Official Business or Official Time. If on OFFICIAL BUSINESS, the corresponding rate (including but not limited to venue, L&D Provider, others) per day, per employee amounting to Php ______ shall be charged against
the salary of the employee in case of absence during the said Learning & Development (L&D) Activity.
APPROVED BY:____________________________________________
Signature Over Printed Name
Immediate Supervisor/Head of Office
This Confirmation sheet may be sent to the Program Administrator (PA) _____________________ or Program Secretariat (Sec) ______________________, via E-mail or Personal Delivery on or before _________________.
Email: _____________________ Personal delivery (Concerned Office) : _____________________ Office Nos.: _____________________
Copy Furnished: PETRO
Date received: ______________
TO-Form No. 022
Revision No. 3.0 05 May 2022
