Sick Leave Forms Blank

Republic of the Philippines
Department of Education
Region X- Northern Mindanao
Division of Lanao del Norte
District of Bacolod
DEMARAO PRIMARY SCHOOL
1st Endorsement
_________________
Respect fully forwarded to the Schools Division Superintendent, DepEd Division of Lanao del Norte,
Pigcarangan, Tubod, Lanao del Norte the attached pertinent documents of Mrs. JENNIFER P. BANQUIL on her application
for sick leave of absence with pay/without pay, with half pay effective _February 28, 2018_ and recommending
approval if found in order.
Enclosed herewith are the following supporting papers to wit;
1. Basic Letter
2. CSC Form No. 6
3. Memorandum
ELIEZER S. LUNTAYAO
(Signature Over Printed Name)
__________________
(Date)
Received by:
___________________
(Signature over Printed Name)
_________________
(Date)
Republic of the Philippines
Department of Education
Region X- Northern Mindanao
Division of Lanao del Norte
_____________________________________________________________________________
February 28, 2018
MEMORANDUM FOR:
The Chief
IBM Commission
Budget Commission
Manila
The application for leave of absence on the record of JENNIFER P. BANQUIL Regular/Perm.Teacher I of
DEMARAO PRIMARY SCHOOL, Bacolod District, Division of Lanao del Norte. Submitted to this office is hereby approved
in accordance with Executive Order No. 284, dated January 19, 1971 as follows:
Granted: Sick leave of absence without pay effective _Feb. 28, 2018.
For the Department of Education:
ROY E. GAZO
Copy furnished: Schools Division Superintendent
JENNIFER P. BANQUIL
TEACHER I
Demarao Primary School
The Regional Director

DepEd Region X, Cagayan de Oro City
Note:
Term for employee or the vacation and sick leave basis.
SERVICE CREDITS FOR FUTURE AND AFTER THIS APPLICATION
VACATION LEAVE SICK LEAVE
________________ _______________
This application ………………………………………. ___________ _____ _____
Balance for future use…………………………….. ________________ _______________
Certified true and correct:
WARNIE B. ADREA
Administrative Officer
CSC Form N. 6
Revised 1984
APPLICATION FOR LEAVE
1. Office/Agency 2. Name (last) (first) (middle)

Deped-District of Bacolod BANQUIL JENNIFER PACULBA
3. Date of Filling 4. Position 5. Salary (Monthly)

August 30 2017 T-I Php 19,620.00
DETAILS OF APPLICATION
6. Type of leaves 6. (b) Where leave will be spent
( ) vacation 1. In case of vacation leave
( ) to seek employment ( ) within the Philippines/
( ) others (specify) __________________________ ( ) abroad ( specify) _______________________
_________________________________________ _____________________________________________
( ) Sick 2. In case of sick leave
( / ) Maternity ( ) in hospital ( specify)
( ) Others ( Specify) __________________________ __________________________________________
__________________________________________ ( ) out patient (specify)
( c) Number of working days __________________________________________
applied for day _____60 days__________ 6. (d) Computation
( ) requested
Inclusive dates ___Aug. 29 to Oct. 29, 2017___ ( ) not requested
7. ( a ) Certificate of leave
Credit as of _______________________________ _______________________________
Signature of applicant
________________________________________________
7. (b ) Recommendation
VACATION SICK TOTAL ( ) approved
( ) disapproval due to
Days days days
WARNIE B. EDREA ELIEZER S. LUNTAYAO

Administrative Officer School Principal
7. ( c ) Approved for 7. ( d ) Disapproval due to

___________________________ days with pay ____________________________________________
___________________________days without pay ____________________________________________
___________________________ others (specify ) ____________________________________________
________________________________
Signature
EMMALINDA E. DUHAYLUNGSOD CESO V

Schools Division Superintendent
________________________
DATE
1. Application for vacation leave or sick leave for one full day or more shall be made on this form to be accomplished at least in duplicate.
2. Application for vacation leave shall filed in advanced or wherever possible (5) days before going on such leave.
3. Application for sick leave filed in advance or exceeding five ( 5 ) days shall be accomplished by a medical consultation was not availed of an affidavit should be
executed by the applicant.
4. An employee who is absent without approval leaves shall not be entitled to receive his/her salary corresponding to the period of his unauthorized leave of
absence.
5. An application for leave of absence for thirty (30) calendar days or more shall be accomplished in a clearance form money and property accountabilities.
6. Signing authorities for the application of sick/vacation/study/maternity leave as per DepEd. 65, s. 2008:
Schools Division Superintendent

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Republic of the Philippines

Enclosed herewith are the following supporting papers to wit;

February 28, 2018

For the Department of Education:

The Regional Director

VACATION LEAVE SICK LEAVE

Certified true and correct:

1. Office/Agency 2. Name (last) (first) (middle)

3. Date of Filling 4. Position 5. Salary (Monthly)

Days days days

WARNIE B. EDREA ELIEZER S. LUNTAYAO

7. ( c ) Approved for 7. ( d ) Disapproval due to

EMMALINDA E. DUHAYLUNGSOD CESO V

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