You are on page 1of 4

APPLICATION FOR LEAVE

1. OFFICE/AGENCY
Department of Education
School:
DIVISION OFFICE
3. DATE OF FILING
August 28, 2015

2. NAME
FIGUEROA

(X)
( )
( )

(Middle Name)

4. POSITION
5. MONTHLY SALARY
PRINCIPAL II
P36, 567.00
DETAILS OF APPLICATION
6.b) WHERE LEAVE BE SPENT

6.a) TYPE OF LEAVE


(

(Last)
(First)
MA. ANGELICA

Vacation
( ) To seek Employment
( ) Others (Specify)

( 1 ) IN CASE OF VACATION LEAVE


( ) Within the Philippines
( ) Abroad (Specify)
_________________________
( 2 ) IN CASE OF SICK LEAVE
( ) In Hospital (Specify) __________
( / ) Out Patient

Sick
Maternity
Others (Specify)

6.c) NUMBER OF WORKING DAYS APPLIED FOR:

6.d) COMMUTATION
( ) Requested

( X ) Not Requeste

1 working days with pay


INCLUSIVE DATE/S

__

__________________________
Signature

August 27, 2015

Employee No. 5173823

DETAILS OF ACTION ON APPLICATION


7.a) CERTIFICATION OF LEAVE CREDITS
7.b) RECOMMENDATION
( / ) Approved
( ) Disapproved due to:

AS OF ________________________

*School Heads (for teaching & non-teaching staf


*Section Heads must initial below the AO's V name

Vacation

Sick

Total

(for Division Administrative Staf only)

Balance
Less
Total

LIZETTE MAY ISABEL N. DIOSO


District Supervisor

MARIZEL T. SENERICHES-RAMIREZ
HR In-charge

*For EPS, PSDS and School Heads

MARIO M. BERMUDEZ
Date
7.c) APPROVED FOR:

OIC- Asst. Schools Division Superintendent


(

*for teaching & non-teaching staf in all schools

___________________________ days with pay


___________________________ days without pay
___________________________ OTHERS ( specify)
7.d) DISAPPROVED DUE TO:
___________________________
___________________________
___________________________

INSTRUCTIONS

) For 15 days & below

____________________________

) For 1 day & above (EPS, PSDS, School Heads &


Division Administratve Staf
For 16 days & above (teaching & non-teaching
staf in all schools

GILDO G. MOSQUEDA, CEO VI


Schools Division Superintendent

1. Application for vacation leave of one full day or more shall be made on this form and to be accomplished at least in duplicate
2. Application for vacation leave shall be filed in advance & approved by concerned official or whenever possible five (5) days before going such leave

3. Application for sick leave filed in advance, or execeding five days shll be accompanied by a medical certificate in case medical
medical consultation was not availed of, an affidavit shall be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his unauthoriezed leave of absences

5. An application of leave of absence for thirty (30) calendar days or more without pay shall be accompanied by a clearance from money or property

responsibilities and Tax Clearance (for vacation leave)

(First)

(Middle Name)
EMPOC

P36, 567.00

E LEAVE BE SPENT

E OF VACATION LEAVE
Within the Philippines
Abroad (Specify)
_________________________
E OF SICK LEAVE
n Hospital (Specify) __________
Out Patient fever

Requested

( X ) Not Requested

__________________________
Signature

Employee No. 5173823

ON
MMENDATION

Disapproved due to:

s (for teaching & non-teaching staf

s must initial below the AO's V name

Administrative Staf only)

TE MAY ISABEL N. DIOSO


District Supervisor

S and School Heads

MARIO M. BERMUDEZ

. Schools Division Superintendent

hing & non-teaching staf in all schools

_________________________

& above (EPS, PSDS, School Heads &


dministratve Staf
& above (teaching & non-teaching

DO G. MOSQUEDA, CEO VI
ools Division Superintendent

t least in duplicate

before going such leave

ate in case medical

om money or property

APPLICATION FOR LEAVE


1. OFFICE/AGENCY
Department of Education
School:
F. ORINGO SR. ES
3. DATE OF FILING
August 28, 2015

2. NAME
FIGUEROA

(X)
( )
( )

(Middle Name)

4. POSITION
5. MONTHLY SALARY
PRINCIPAL II
P36, 567.00
DETAILS OF APPLICATION
6.b) WHERE LEAVE BE SPENT

6.a) TYPE OF LEAVE


(

(Last)
(First)
MA. ANGELICA

Vacation
( ) To seek Employment
( ) Others (Specify)

( 1 ) IN CASE OF VACATION LEAVE


( ) Within the Philippines
( ) Abroad (Specify)
_________________________
( 2 ) IN CASE OF SICK LEAVE
( ) In Hospital (Specify) __________
( / ) Out Patient

Sick
Maternity
Others (Specify)

6.c) NUMBER OF WORKING DAYS APPLIED FOR:

6.d) COMMUTATION
( ) Requested

( X ) Not Requeste

1 working days with pay


INCLUSIVE DATE/S

__

__________________________
Signature

August 27, 2015

Employee No. 5173823

DETAILS OF ACTION ON APPLICATION


7.a) CERTIFICATION OF LEAVE CREDITS
7.b) RECOMMENDATION
( / ) Approved
( ) Disapproved due to:

AS OF ________________________

*School Heads (for teaching & non-teaching staf


*Section Heads must initial below the AO's V name

Vacation

Sick

Total

(for Division Administrative Staf only)

Balance
Less
Total

MARIO M. BERMUDEZ
District Supervisor
*For EPS, PSDS and School Heads

HR In-charge
GILDO G. MOSQUEDA, CEO VI
Date
7.c) APPROVED FOR:

Schools Division Superintendent


(

) For 15 days & below


*for teaching & non-teaching staf in all schools

___________________________ days with pay


___________________________ days without pay
___________________________ OTHERS ( specify)

GILDO G. MOSQUEDA, CEO VI


Schools Division Superintendent

7.d) DISAPPROVED DUE TO:


___________________________
___________________________
___________________________

INSTRUCTIONS

) For 1 day & above (EPS, PSDS, School Heads &


Division Administratve Staf
For 16 days & above (teaching & non-teaching
staf in all schools

GILDO G. MOSQUEDA, CEO VI


Schools Division Superintendent

1. Application for vacation leave of one full day or more shall be made on this form and to be accomplished at least in duplicate
2. Application for vacation leave shall be filed in advance & approved by concerned official or whenever possible five (5) days before going such leave

3. Application for sick leave filed in advance, or execeding five days shll be accompanied by a medical certificate in case medical
medical consultation was not availed of, an affidavit shall be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his unauthoriezed leave of absences

5. An application of leave of absence for thirty (30) calendar days or more without pay shall be accompanied by a clearance from money or property

responsibilities and Tax Clearance (for vacation leave)

(First)

(Middle Name)
EMPOC

P36, 567.00

E LEAVE BE SPENT

E OF VACATION LEAVE
Within the Philippines
Abroad (Specify)
_________________________
E OF SICK LEAVE
n Hospital (Specify) __________
Out Patient fever

Requested

( X ) Not Requested

__________________________
Signature

Employee No. 5173823

ON
MMENDATION

Disapproved due to:

s (for teaching & non-teaching staf

s must initial below the AO's V name

Administrative Staf only)

MARIO M. BERMUDEZ
District Supervisor

S and School Heads

O G. MOSQUEDA, CEO VI

ools Division Superintendent

hing & non-teaching staf in all schools

O G. MOSQUEDA, CEO VI

ools Division Superintendent

& above (EPS, PSDS, School Heads &


dministratve Staf
& above (teaching & non-teaching

DO G. MOSQUEDA, CEO VI
ools Division Superintendent

t least in duplicate

before going such leave

ate in case medical

om money or property