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Empleado(a) Nombre de (de la) Empleado(a) Seguro Social Rango Acad mico Facultad/Escuela Decanato Departamento Tipo de nombramiento Incluya evidencia m dica para acreditar condici n y d as que espera estar fuera del trabajo Firma del Personal Docente Fecha PARA SER COMPLETADO POR LA OFICINA DE RECURSOS HUMANOS Balance de Licencia al: D as Cedidos del Fondo de Reserva Ordinaria' Enfermedad Agota balance al A partir de- (Si no es aprobada razones para la denegacion) Certifico que.

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