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Leave-Paper-Front

The document is an application for leave submitted by Cheryl Jane Agudo, a Teacher I at DepEd-Albay Division, requesting one day of maternity leave on October 4, 2024. It includes details about the type of leave, the applicant's position, and salary. The application also contains sections for leave credits certification and recommendations for approval or disapproval by authorized officers.

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agudocheryljane
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8 views

Leave-Paper-Front

The document is an application for leave submitted by Cheryl Jane Agudo, a Teacher I at DepEd-Albay Division, requesting one day of maternity leave on October 4, 2024. It includes details about the type of leave, the applicant's position, and salary. The application also contains sections for leave credits certification and recommendations for approval or disapproval by authorized officers.

Uploaded by

agudocheryljane
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Civil Service Form No.

6
ANNEX A
Revised 2020
Republic of the Philippines
Department of Education
REGION V (Bicol)
SCHOOLS DIVISION OFFICE OF ALBAY
Ligñon Hill, Bogtong, Legazpi City
email add: albay@deped.gov.ph
Tel. No.: (052)7425380/ (052)7425381

APPLICATION FOR LEAVE


1. OFFICE/DEPARTMENT 2. NAME: (Last) (First) (Middle)

DEPED-ALBAY DIVISION/NABASAN ES AGUDO CHERYL JANE MUSA

3. DATE OF FILING OCTOBER 04, 2024 4. POSITION TEACHER I 5. SALARY Php 28,796.00

6. A TYPE OF LEAVE TO BE AVAILED OF 6. B DETAILS OF LEAVE


Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O.No.292)
/Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Within the Philippines ______________
 Maternity Leave (R.A. No. 11210/IRR issued by CSC, DOLE and SSS)
Abroad (Specify) __________________
Type equation here .
Paternity Leave (R.A. No. 8187/CSC MC No. 71, s. 1998, as amended) In case of Sick Leave:
In Hospital (Specify Illness)__________
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Solo Parent Leave (R.A. No. 8972/ CSC MC No. 8, s. 2004) Out Patient (Specify Illness) _________
 SEIZURE DISORDER______________
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
In case of Special Leave Benefits for Women:
10-Day VAWC Leave (RA No. 9262/CSC MC No. 15, s. 2005)
(Specify Illness)_________________________
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
______________________________________
Special Leave Benefits for Women (RA No. 9710/CSC MC No. 25, s. 2010) In case of Study Leave:
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Completion of Master’s Degree
Adoption Leave (R.A. No. 8552) BAR/Board Examination Review
/ purpose:
Other
Monetization of Leave Credits
Others:
Terminal Leave
____________________________________

6. C NUMBER OF WORKING DAYS APPLIED FOR 6. D COMMUTATION


(1) day Not Requested
INCLUSIVE DATES Requested
OCTOBER 4, 2024
____________________________________
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION
7. A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
For approval
As of _________________________________
For disapproval due to ____________________
Vacation Leave Sick Leave _______________________________________
Total Earned _______________________________________
Less this application _______________________________________
Balance

JONATHAN O. MADRIDANO
MARIANNE B. BUSTAMANTE (Authorized Officer)
(Authorized Officer)

7. C APPROVED FOR: 7. D DISAPPROVED DUE TO:


_________ days with pay ______________________________________
_________ days without pay ______________________________________
_________ others (Specify) ______________________________________

__________________________________
(Authorized Official)

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