ANNEX A Republic of te Boitinines tr) Departs f Cova ee ‘SCHOOLS DIVISION OF MISAMIS ORIENTAL APPLICATION FOR LEAVE [i GFFICEIDEPARTVENT 7 NAME) is) way Ss. OaTE OF FILING 4 PosmoNn 5 SALARY 6. DETAILS OF APPLICATION [BA TWPE OF Leave TOBE AVALED OF 5B DETALS OF LEAVE D1 Vocation Leave sxe 51, Rex, Oreos Rue ienerra © Ne 282) ‘Incase of Vacaton’Special Priviege Leave: 1 venoonirocsdtenvore it hisxncueatorvamenneane | E] Yinnercores o= 1 reve cen) a TED scx cove iss oe omni Ru npoerng 0 Na 25) case of Sik Leave [1 Maternity Leave ves no 112107 roienes C5, COLE ands) 1 tr Hospta Specify tiness) TE PatorityLaave ea No e187/CSEME Ne 7.5 188 same) 1 owPatientspecity tines, Toei Ptage Leave es 31 Aun Orns inparirg Ne oe o= ‘oF Speci! Leave Benois for Women 1D ser Parent Leave ann ears Meno 208 (Speci tres) study Leave ise 0, nue Crntus Rus nsemanirg £0 No. 282 Incase D1 say vawe Leave ane sot /cSeMc he 1 « 208) of Study Leave TF nation Prilage ce 6 nae omaha to.ne | LE] Compton Masters Depron o= LE. eastoard Examination Review Other Special Leave Benefits for Women fo #70/686 MCW 24 «200 purpose: ‘Special Emergency (Calamity) Leave csc ns 252012 xanann Adopton |” [1] Menetzaton of eave Creat Leaveym No. 1882) 1 terminal Leave omens [s@-WOMBER OF WORKING DAYS APPLIED FOR ls COMMUTATION paeeineiinenineninniieatnnS 1 NotReaestes INCLUSIVE DATES BI reavess ‘Sianatare of Appa 7. DETAILS OF ACTION ON APPLICATION [7A CERTIFICATION OF LEAVE CREDITS: ener 7 RECOMMENDATION ‘Vacaton awe [Sex leave or apeova Tota Eamed BD Ferdsspproval duet Tassie apptcaton Balance ‘Tashorzes Onan rors Oca Ic APPROVED FOR 7B DSAPPROVED DUE TO. ays with pay hers (SPE ays winout pay athorzed OF‘Applicaton for any ype of eave shal be made on this Form and {tobe accomplished atleast In duplicate with cocumentary Tequrements as flows 4. Vacation leave" It shall be fled five (5) days in advance, whenever possible, of the effective data of such leave. Vacation leave within inthe Philppines or abroad. shall be indicated in the form for purpotes of eecuring travel authority and completing clearance from money and work accountabities 2. MandatoryForced leave “Annual five-day vacation leave shall be forfeted if nt taken during tne year. In case the scheduled leave has deen Cancelled in the exigency ofthe service by the head of agency I hall no longer be deducted fom the accumblated vacation leave. Avaiment af one (1) day oF more Vacation Leave (VL) shall be considered for complying the mandatoryrorced leave fubject to the conditions under Section 25, Rule XVI of the (Omnibus Rules implementing € 0.1No. 292, 3. Sick leaver * It shall be fied immediately upon employee's return from such leave + It fied in advance or exceeding five (5) days, application shall be accompaned by a medical cerficate In case medical Consuitatan was. not availed of, an alldavi should be ‘executed by an applicant 4. Matornity leave — 105 days + Proof of pregnancy e.g. ultrasound, doctor's cortfcate on the ‘expected date of delivery + Accomplished Notice of Allocation of Maternity Leave Credits (CS Form No. 6a), i'peedes + Seconded female employees shat enjoy maternity leave with fal pay inthe recipient agency. 5. Patornity leave -7 days Proof of child's delivery e.9. bith certfcate, medical crificate and mariage contract 65. Special Privilege leave - 3 days Te shall be fled/approved for atleast one (1) week prior to availment, except on emergency cases. Special privlege leave within the Priippines or abroad shal be indicated inthe foam for purposes of securing travel authority and completing ‘learance from money and work accountabites 17. Solo Parent leave ~7 days Itshal be fled in advance or whenever possible fve (5) days before going on such leave with updated Solo Parent Identification Card 8. Study loavo" ~ up to 6 months * Shall meet the agency’s internal requirements, any * Contract between the agency. pead or authorized representative and the employee concerned 9. VAWC leave - 10 days. + shal be fled in advance or immediately upon the woman employee's return from such leave + shall be accompanied by any ofthe following supporting ocuments 8.Barangay Protection Order (BPO) obtained from the barangay, b.TemporayPermanent Protection Order (TPOIPPO) ‘obtained from the court; «Ife protection erder isnot yet issued by the barangay oF the court, a cefiicaton issued by the Punong Barangayikagawad or Proseculor or the Cierk of Cout that the application forthe BPO, TPO or PPO has been fled with the $2. offee shall be sufficient to. support the ‘pplication forthe ten-day leave; 0° In the absence of the EPO/TPCIPPO of the cetfcation, a police report speciving the datas of the occurrence of Yolence on the vielm and a medical cetiicate may be ‘considered atthe discretion of the immeskate supervisor of the woman employee concerned 40. Rohabiltation lave" - up to 6 months * Applicaton shall be made within one (1) week from the tie ofthe acesdent excep! when a longer period is warranted + Letter request supperted by relevant reports such as the police repor. any. Medical ceatficate on the nature of he injuries, the course of treatment iolwed. and. the need to undergo res, recuperation, and ehabiliaion, as te case may be + Wiaten concurence of 2 goverment physician should be ‘obtained relative tothe recommendation for rehabiaton if the attending physician is private practioner, particularly fon the duraton of he period of renabiltation, 11, Special loave benefits for women” - up to 2 monthe * The application may be fled in advance, thats, a least five (6) days prior Io the scheduled date of the gynecological Surgery that wil be undergone by the employee. incase of femergency, the application for special leave shel be fed Immediately upon employee's return but during confinement the agency shall be notifed of said surgery. + The application shall be accompanied. by a medical Cerificate filed ouby the proper medical authors, e9.the Batlending surgeon accompanied by clinical summary Fellecing the gynecological disorder which shall be Adcressed or was addressed by the said surgery, the Fistopathological report the operative echaique used forthe suigery, the duration of the surgery incliding the peroperative period (period of confinement around surgen)}. 88 well as the employees estimated period of recuperation for the same 412, Spocial Emorgoncy (Calamity) leave - up to 5 days +The special emergency leave can be applied fora maximum of fve (5) straight working days or staggered basis within thay (30) days from the actual occurrence of the natural calamityidisaster. Said privilege shall be enjoyed ance @ year, notin every instance of calamity or disaster. + The head of offee shal take full esponsibity forte grant of special emergency leave and vetiicaion of he employee's eigblly to be granted thereat. Said veriicaton shallinclude: valdaton of place of residence based on latest avaiable records ofthe affected employee: verifcation that the place of residence is covered in the declaration of calamity area by the proper government agency, and such bother proofs as may be necessary 19, Monetization of leave credits ‘Application for monetization of tiy percent (50%) oF more of the accumulated leave credits shall be accompanied by ltr request to the head of the agency stating’ the valit-and justfable reasons.