OFFICE OF MEDICAL EDUCATION
LEAVE APPLICATION FORM
Name (Last, First, Middle)
Position
Address
Type of Leave:
 Vacation Leave
 Maternity/Paternity Leave
 Educational Leave
 Sick Leave
 Others: ________________________
Accomplished by:
____________________________
Signature over Printed Name
Total No. of Available Leaves
Number of Days Taken
Remaining Leave Balance
GC-MED-***-OME-4-01-02 03/09
Name (Last, First, Middle)
Position
Address
Type of Leave:
 Vacation Leave
 Maternity/Paternity Leave
 Educational Leave
 Sick Leave
 Others: ________________________
Accomplished by:
____________________________
Signature over Printed Name
Total No. of Available Leaves
Number of Days Taken
Remaining Leave Balance
GC-MED-***-OME-4-01-02 03/09
(Residents and Fellows)
Date Filed:
Department/Institute/Center Year Level:
Contact No:
From: ___________, 20 _______ to ___________, 20 _______ Total No. of Days: _______
Reason: ___________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Recommended by: Approved by:
____________________________
Chief Resident/Fellow
____________________________
____________________________ AMD for Medical Education
Residents’/Fellows’ Training Officer
____________________________
Department Chairman/
Institute Director/Center Head
For Office of Medical Education Use Only
Remarks: Received by:
OFFICE OF MEDICAL EDUCATION
LEAVE APPLICATION FORM
(Residents and Fellows)
Date Filed:
Department/Institute/Center Year Level:
Contact No:
From: ___________, 20 _______ to ___________, 20 _______ Total No. of Days: _______
Reason: ___________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Recommended by: Approved by:
____________________________
Chief Resident/Fellow
____________________________
____________________________ AMD for Medical Education
Residents’/Fellows’ Training Officer
____________________________
Department Chairman/
Institute Director/Center Head
For Office of Medical Education Use Only
Remarks: Received by:
 Guidelines for Filing of Leaves
1. Vacation Leave (VL)
1.1. VL is non-cumulative and shall be taken within the year where it is credited. Unused VL shall be forfeited.
1.2. Application for VLs shall be filed within one (1) week prior to the effective date. Failure to comply may cause the disapproval of
the intended leave. Please be reminded that an application is not considered approved unless signed by all concerned.
1.3. Any changes to or cancellation of filed application for VL shall be in writing and shall be submitted to the Office of Medical
Education, three (3) working days before payroll cut-off.
2. Maternity Leave
2.1. Application for Maternity Leave shall be supported with a Medical Certificate from the Attending Physician.
2.2. Shall not exceed 60 days for NSD and 78 days for CS.
3. Paternity Leave
3.1. Paternity Leave shall be availed not later than 60 days after the date of delivery of the legal wife of the Resident/Fellow.
3.2. Marriage Certificate and Birth Certificate of the Child shall be attached to the form.
4. Educational Leave
 Educational Leave shall depend on the schedule of the Postgraduate Course, convention, research and other continuing educational
activities. Senior Residents may avail of maximum of 5 days per year.
5. Sick Leave
 Application for Sick Leave shall not be approved without the Medical Certificate.
6. Replacement of Leaves
 Maternity/Paternity/Educational Leave shall be made up on a 1:1 ratio (i.e., 1 day leave is equivalent to 1 day make-up duty,
weekday-weekday, weekend/holiday-weekend/holiday)
7. The Resident/Fellow shall fill up the Leave Application Form completely and accurately
 Leave forms with incomplete information will not be processed. A Leave Application needs to be signed by all concerned to be
considered official, otherwise one is at risk of being AWOL.
8. Leave Application form shall be approved by the following:
 Training Officer of respective Department/Institute/Center
 Head of the concerned Department/Institute/Center
 AMD for Medical Education

Guidelines for Filing of Leaves

1. Vacation Leave (VL)
1.1. VL is non-cumulative and shall be taken within the year where it is credited. Unused VL shall be forfeited.
1.2. Application for VLs shall be filed within one (1) week prior to the effective date. Failure to comply may cause the disapproval of
the intended leave. Please be reminded that an application is not considered approved unless signed by all concerned.
1.3. Any changes to or cancellation of filed application for VL shall be in writing and shall be submitted to the Office of Medical
Education, three (3) working days before payroll cut-off.
2. Maternity Leave
2.1. Application for Maternity Leave shall be supported with a Medical Certificate from the Attending Physician.
2.2. Shall not exceed 60 days for NSD and 78 days for CS.
3. Paternity Leave
3.1. Paternity Leave shall be availed not later than 60 days after the date of delivery of the legal wife of the Resident/Fellow.
3.2. Marriage Certificate and Birth Certificate of the Child shall be attached to the form.
4. Educational Leave
 Educational Leave shall depend on the schedule of the Postgraduate Course, convention, research and other continuing educational
activities. Senior Residents may avail of maximum of 5 days per year.
5. Sick Leave
 Application for Sick Leave shall not be approved without the Medical Certificate.
6. Replacement of Leaves
 Maternity/Paternity/Educational Leave shall be made up on a 1:1 ratio (i.e., 1 day leave is equivalent to 1 day make-up duty,
weekday-weekday, weekend/holiday-weekend/holiday)
7. The Resident/Fellow shall fill up the Leave Application Form completely and accurately
 Leave forms with incomplete information will not be processed. A Leave Application needs to be signed by all concerned to be
considered official, otherwise one is at risk of being AWOL.
8. Leave Application form shall be approved by the following:
 Training Officer of respective Department/Institute/Center
 Head of the concerned Department/Institute/Center
 AMD for Medical Education