APPLICATION FOR LEAVE

1. OFFICE: Department of Education 2. Surname: First Name: M.I:

District/School: Wawang Elementary School – Ballesteros District TADEJA, FRANCE JACKSON C.
3. DATE OF FILLIG: 4. POSITION: 5. MONTHLY SALARY:
October 20, 2017 Teacher – III ₱ 23,257.00
DETAILS FOR APPLICATION
6. a. TYPE OF LEAVE 6. B. WHERE LEAVE WILL BE SPENT
(1)______VACATION LEAVE (1) IN CASE OF VACATION LEAVE
( ) To seek employment ( ) Within the Philippines
( ) Others (Specify) To attend National Youth Day ( ) Abroad (Specify) __________________
(2) ______ SICK LEAVE (2) IN CASE OF SICK LEAVE
(3) ______ MATERNITY LEAVE ( ) In Hospital (Specify) ________________
(4) ______ PATERNITY LEAVE ( ) Outpatient (Specify) _______________
(5) ______ PARENTAL LEAVE ( ) Others (Specify) ___________________
(6) ______ PRIVILEGE LEAVE – MC 6 (SPECIFY)________________
(7) ______ MONETIZATION LEAVE _________________________
(8) ______ TERMINAL LEAVE

ADDITIONAL DATA: 6.d. COMMUTATION

( ) Medical Certificate Attached ( ) Requested ( ) Not Requested
( ) Clearance Attached
( ) Others (Specify)_______________

6. c. Inclusive Dates: November 6 – 11, 2017

Number of days applied for: ____5 days____
FRANCE JACKSON C. TADEJA
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. a. CERTIFICATION OF LEAVE CREDITS 7. b. RECOMMENDATION
( ) APPROVAL
BALANCE AS OF ___________________ ( ) Disapproval due to ___________________
___________________________________
Vacation Sick Total
Leave Balance ___________ __________ _______
Less this Leave ___________ __________ _______
Leave Balance ___________ __________ _______

_______________________________ MARIA JODELYN P. URATA, Ph. D.

Personnel Officer School Principal/Chief Admin. Officer

7. c. APPROVED FOR 7. d. DISAPPROVED DUE TO:

__________________ Days with pay __________________________________________________
__________________ Days without pay __________________________________________________
__________________ Others (Specify) __________________________________________________

LEILA P. AREOLA, Ph. D., CESO VI

Officer – in – Charge
Schools Division Superintendent
________________
Date
1. Application for vacation or sick leave for one full day or more shall be made on this form and accomplished in duplicate.
2. Application for vacation leave shall be filled in advance or whenever possible five (5) days before going to such leave.
3. Application for sick leave filled in advance, a medical certificate shall accompany exceeding five (5) days. In case of medical
consultation was not available, the applicant should execute an affidavit.
4. An employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding to the period
of his/her unauthorized leave of absence.
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by clearance from money, and
property accountabilities