.
Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
CITY SCHOOLS DIVISION OF CABUYAO
APPLICATION FOR LEAVE
1. OFFICE/DEPARTMENT 2. NAME : (Last) (First)
SANCHEZ, ALEX SOLLEZA
October 4- 12, 2021
3. DATE OF FILING ______________ Teacher III
4. POSITION _____________________________ 5. SA
6. DETAILS OF APPLICATION
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/Specia
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)
Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS) In case of Sick Leave:
Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended)
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004) ______________________
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Special Leave B
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)
Adoption Leave (R.A. No. 8552)
Other purpose:
Others:
Paternity Leave
_____________________________________
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION
7 DAYS
________________________________________
INCLUSIVE DATES
10- 4- 12, 2021
________________________________________
(Signature
7. DETAILS OF ACTION ON APPLICATION
7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of _______________________
Vacation Leave Sick Leave
Total Earned
Less this application
Balance
JHOANNA M. MANZANERO
JHOANNA M. MANZANERO
Administrative Officer IV (HRMO) Authorize
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO
_______ days with pay
_______ days without pay
_______ others (Specify)
NEIL G. ANGELES, EdD
_________________________________
Authorized Signatory
Address: Cabuyao Enterprise Park, Cabuyao Athletes Basic School (CABS),
Brgy. Banay-Banay, Cabuyao City, Laguna
Telephone No.: (049) 545 4597 / (049) 545 4878
Email Address: division.cabuyao@deped.gov.ph
Website: depedcabuyao.ph
Website: depedcabuyao.ph
Republic of the Philippines
artment of Education Stamp of Date of Receipt
EGION IV-A CALABARZON
CHOOLS DIVISION OF CABUYAO
CATION FOR LEAVE
ME : (Last) (First) (Middle)
SANCHEZ, ALEX SOLLEZA
Teacher III
SITION _____________________________ P 25, 232
5. SALARY _______________
DETAILS OF APPLICATION
6.B DETAILS OF LEAVE
In case of Vacation/Special Privilege Leave:
Within the Philippines __________________________
Abroad (Specify) _____________________________
In case of Sick Leave:
In Hospital (Specify Illness) _____________________
Out Patient (Specify Illness) ____________________
_____________________________________________
In case of Special Leave Benefits for Women:
(Specify Illness) ________________________________
_____________________________________________
In case of Study Leave:
Completion of Master's Degree
BAR/Board Examination Review
Other purpose:
Monetization of Leave Credits
Terminal Leave
6.D COMMUTATION
Not Requested
Requested
(Signature of Applicant)
LS OF ACTION ON APPLICATION
7.B RECOMMENDATION
For approval
For disapproval due to ________________________
___________________________________________
___________________________________________
___________________________________________
MA. NINA S. GACHE
___________________________________________
Authorized Signatory
7.D DISAPPROVED DUE TO:
_______________________________________
___________________________________________
___________________________________________
EIL G. ANGELES, EdD
____________________________
Authorized Signatory
Athletes Basic School (CABS),
aguna
5 4878
.gov.ph
AUTHORIZED SIGNATORIES (DepEd Order No. 2, s. 2021)
Up to 60 Calendar days More than 60 Calendar Days to One (1) Year
OFFICE/POSITION
Recommending Approval Approval Recommending Approval Approval
DIVISION OFFICE
SDS / ASDS ARD RD ARD RD
Division Chief ASDS SDS ASDS SDS
Below Division Chief* Division Chief ASDS Division Chief and ASDS SDS
SCHOOL
Principal / Head Teachers / TIC ASDS SDS ASDS SDS
Teachers and non-teaching personnel School Head ASDS School Head and ASDS SDS
*Applications of employees under the direct supervision of the RD / SDS shall be recommended by the ARD / ASDS and approved by the RD / SDS,
respectively
