Republic of the Philippines

Department of Public Works and Highways

OFFICE OF THE REGIONAL DIRECTOR
Region IX, Zamboanga City

OPERATORS OPERATIONAL RECORD

OPR NO. :
Date
Name of Operator : DPWH NO.:
Type of Equipment : ERRO NO. :
Purpose :
Project Location :
Requested by: No. of days

APPROVED:

EFREN D. AQUINO
Engineer III
TO BE FILLED UP BY THE OPERATOR Br Motor RDG after operation
Hr Motor ACG before operation
Date Hours Date Hours Total Operation Hours

TOTAL NO. OF DAYS OOPERATION:

DATE
Fuel issued days
Bal. of last Operation
Issued Today
Used during Operation
Total
Used during Operation
Balance after Operation

TOTAL FUEL ISSUED liters DATE OF LAST REQUISITION

LUBRICANTS ISSUED GREASE/OTHERS

Balance of last operation

Issued Today
Total
Used during operation
Balance after operation
REMARKS:
 (Operator)

I HEREBY CERTIFY that the equipment was used on official business as shown above.

Name
 Republic of the Philippines
Department of Public Works and Highways
OFFICE OF THE REGIONAL DIRECTOR
Equipment Management Division
Region IX, Tetuan, Zamboanga City
Republic of the Philippines
Department of Public Works and Highways
OFFICE OF THE REGIONAL DIRECTOR
Equipment Management Division
Region IX, Tetuan, Zamboanga City

NO.: NO.: _________

ORDER SLIP ORDER SLIP
DATE DATE ______________

ORDERED BY: DPWH - Equipment Management Division ORDERED BY: DPWH - Equipment Management Division

Vehicle ___________________ Plate No. Vehicle _________________ Plate No.

Qty. Unit DESCRIPTION Unit Price Amount Qty. Unit DESCRIPTION Unit Price Amount
SUPER SUPER
UNLEADED UNLEADED
REGULAR REGULAR
KEROSENE KEROSENE
DIESEL DIESEL
MOTOR OIL MOTOR OIL

TOTAL P TOTAL P
Received By: Approved By: Received By: Approved By:

________________ JAIME ARISTON G. YANOS ________________ JAIME ARISTON G. YANOS

Driver Chief-EMD Driver Chief-EMD

Republic of the Philippines Republic of the Philippines

Department of Public Works and Highways Department of Public Works and Highways
OFFICE OF THE REGIONAL DIRECTOR OFFICE OF THE REGIONAL DIRECTOR
Equipment Management Division Equipment Management Division
Region IX, Tetuan, Zamboanga City Region IX, Tetuan, Zamboanga City

NO.: NO.: __________

ORDER SLIP ORDER SLIP
DATE DATE
ORDERED BY: DPWH - Equipment Management Division ORDERED BY: DPWH - Equipment Management Division

Vehicle Plate No. Vehicle Plate No.

Qty. Unit DESCRIPTION Unit Price Amount Qty. Unit DESCRIPTION Unit Price Amount
SUPER SUPER
UNLEADED UNLEADED
REGULAR REGULAR
KEROSENE KEROSENE
DIESEL DIESEL
MOTOR OIL MOTOR OIL

TOTAL P TOTAL P
Received By: Approved By: Received By: Approved By:

_______________ JAIME ARISTON G. YANOS _________________ JAIME ARISTON G. YANOS

Driver Chief-EMD Driver Chief-EMD
 Republic of the Philippines Republic of the Philippines
Department of Public Works and Highways Department of Public Works and Highways
OFFICE OF THE CHIEF, EQUIPMENT MANAGEMENT DIVISION OFFICE OF THE CHIEF, EQUIPMENT MANAGEMENT DIVISION

ROUTING SLIP ROUTING SLIP

_____________
(Date)
Reference No. Reference No.

FROM : The Chief, Equipt. Management Division FROM : The Chief, Equipt. Management Division

TO : ( ) Asst. Division Chief TO : ( ) Asst. Division Chief

( ) ________________________ ( ) ________________________

FOR : ( ) Action / Urgent FOR : ( ) Action / Urgent

( ) Appropriate Action
( ) For Dissemination
( ) Investigation & Report
( ) Reply/Indorsement/Transmittal
( ) Comment / Recommendation
( ) Represent Me
( ) See Me
( ) Confer With ____________
( ) Record/File
Remarks:
_________________________________
_________________________________
_________________________________
( ) Appropriate Action
( ) For Dissemination
( ) Investigation & Report
( ) Reply/Indorsement/Transmittal
( ) Comment / Recommendation
( ) Represent Me
( ) See Me
( ) Confer With ____________
( ) Record/File
Remarks:
_____________________________________
_____________________________________
_____________________________________

______________ _________
Signature

Republic of the Philippines Republic of the Philippines

Department of Public Works and Highways Department of Public Works and Highways
OFFICE OF THE CHIEF, EQUIPMENT MANAGEMENT DIVISION OFFICE OF THE CHIEF, EQUIPMENT MANAGEMENT DIVISION

ROUTING SLIP ROUTING SLIP

_____________
Date
Reference No. Reference No.

FROM : The Chief, Equipt. Management Division FROM : The Chief, Equipt. Management Division

TO : ( ) Asst. Division Chief TO : ( ) Asst. Division Chief

 ( ) ________________________
FOR : ( ) Action / Urgent
( ) Appropriate Action
( ) For Dissemination
( ) Investigation & Report
( ) Reply/Indorsement/Transmittal
( ) Comment / Recommendation
( ) Represent Me
( ) See Me
( ) Confer With ____________
( ) Record/File
Remarks:
__________________________________
__________________________________
__________________________________
______________
Signature
( ) ________________________
FOR : ( ) Action / Urgent
( ) Appropriate Action
( ) For Dissemination
( ) Investigation & Report
( ) Reply/Indorsement/Transmittal
( ) Comment / Recommendation
( ) Represent Me
( ) See Me
( ) Confer With ____________
( ) Record/File
Remarks:
____________________________________
____________________________________
____________________________________
_________
ENT MANAGEMENT DIVISION

TING SLIP
_____________
(Date)

, Equipt. Management Division

Division Chief
____________________

priate Action
issemination
igation & Report
/Indorsement/Transmittal
ment / Recommendation

r With ____________

_________________________
_________________________
_________________________

______________
Signature

and Highways
ENT MANAGEMENT DIVISION

TING SLIP
______________
(Date)

, Equipt. Management Division

Division Chief
____________________

priate Action
issemination
igation & Report
/Indorsement/Transmittal
ment / Recommendation

r With ____________

____________________
____________________
____________________

______________
Signature
 Department of Public Works and Highways Department of Public Works and Highways
Zamboanga City Zamboanga City
PERSONNEL GATE PASS PERSONNEL GATE PASS
Name: _______________________________________________ Name:
Position _______________________________________________ Position
Division _______________________________________________ Division

PURPOSE OF GOING OUT: ____________________________ PURPOSE OF GOING OUT:

Please Checks Official Personal Please Checks Official Personal

EFFECTIVITY DATE : ___________________________________ EFFECTIVITY DATE : _________________________

REQUESTED TIME OF DEPARTURE : ____________________________ REQUESTED TIME OF DEPARTURE : _____________

EXPECTED TIME OF RETURN : _________________________________ EXPECTED TIME OF RETURN : __________________

REQUESTED BY: ____________________________________ REQUESTED BY: __________________

APPROVED: APPROVED:

EFREN D. AQUINO JAIME ARISTON G. YANOS

Engineer IV Chief, Equipment Management Division

For & in the absence of the Chief-EMD

(To be filled out by Security Guard on Duty) (To be filled out by Security Guard on Duty)

Time of Departure : _________ Guard's Time of Departure : ______ Guard's

Time of Return : __________ Signature Time of Return : ________ Signature

Department of Public Works and Highways Department of Public Works and Highways
Zamboanga City Zamboanga City
PERSONNEL GATE PASS PERSONNEL GATE PASS
Name: Name:
Position Position
Division Division

PURPOSE OF GOING OUT: PURPOSE OF GOING OUT:

Please Checks Official Personal Please Checks Official Personal
EFFECTIVITY DATE : EFFECTIVITY DATE :

REQUESTED TIME OF DEPARTURE : __________________ REQUESTED TIME OF DEPARTURE : ________________

EXPECTED TIME OF RETURN : _______________________ EXPECTED TIME OF RETURN : _____________________

REQUESTED BY: ___________________________ REQUESTED BY: _________________________

APPROVED: APPROVED:

JAIME ARISTON G. YANOS JAIME ARISTON G. YANOS

Chief, Equipment Management Division Chief, Equipment Management Division

(To be filled out by Security Guard on Duty) (To be filled out by Security Guard on Duty)

Time of Departure : ___________ Guard's Time of Departure : _________ Guard's

Time of Return : ____________ Signature Time of Return : __________ Signature

 Republic of the Philippines
Department of Public Works and Highways

APPLICATION FOR MONETIZATION OF LEAVE CREDITS

(Pursuant to Section 22-24, Rule XVI, CSC Law and Rules)

Box A: To filled by Applicant

DUGENIO ROEL R Crafts & Trade Helper I AES IX-03A

Last Name First Name Middle Name Position Office

Pls. Check: Reason for Request (only for 50% Monetization)

10 days of VL

50% of VL & SL

2/6/2014
Signature Date
Date Received

Box B: To be filled up by the Personnel Division

This is to certify that the Application has a monthly Salary of
P 9,273.00 and the following leave credits Prepared by:
Sick Leave Total no. of days to
Vacation Leave (only for 50% be monetized ELIZABETH R. LUSPO
Monetization

Balance as of 12/13 19.518 19.575

Less: this application 9.759 9.787 19.546
Net Balance 9.759 9.788

Box C: To filled by Budget Division Date Received: __________

9,273.00 x 0.047809 x 19.546 P 8,665.33

Monthly Salary of Applicant No. of days to be monetized

This is to certify that funds are available for payment of this request monetized leave.

Certified by:

FELISA VICTORIA F. TAN

Budget Officer III
Box D: To be signed by Authorites
 APPROVED:

JAIME ARISTON G. YANOS JORGE U. SEBASTIAN, JR., CESO III

Chief, Equipment management Division Regional Director

Box E: To be signed by Chief, Personnel Division

This is to certify that 9.759 days of Vacation Leave and 9.787 days of Sick Leave have been
deducted from the leave balance of Application and the claim for P_8,665.33 representing the money
value of the monetized leave may now be processed.

ROSE MARIE R. ADJAWIE

Administrative Officer V
Chief, Administrative Division

Republic of the Philippines

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE REGIONAL DIRECTOR
Region IX, Zamboanga City
Tel. No. 993-3000

APPLICATION FOR LEAVE

1. DIVISION/OFFICE 2. NAME (Last) (First) (Middle)

EMD MACAPAGAL ROLAND JESUS F.

3. Date of Filing 4. Position 5. Salary (No. Daily)

16-Jul-13 Auto Equipment Inspector

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b.) WHERE LEAVE WILL BE SPENT

Vacation - E.O.1077 - FORCED LEAVE (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)

Otherss (specify) CSC MC 06S. 1999

Special Privilege Leave Out Patient (specify)

6. c) NUMBER OF WORKING DAYS APPLIED FOR: 6.d) COMMUTATION

3.000 working day- Vacation Leave with pay Requested Not Requested

INCLUSIVE DATES: July 31 to August 1 & 2, 2013

ROLAND JESUS F. MACAPAGAL
Signature of Applicant

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION

VAC. SICK
Approved
Bal. as of 6-30-13 128.414 189.000
Less: this application 3.000 Disapproved due to
Net Balance 125.506 189.000

AMALIA Z. PATAGOC EFREN D. AQUINO

Administrative Officer V Engineer III
Recommending Approval
7. c) APPROVED 7. d) DISAPPROVED DUE TO:
3.000w. day Vacation Leave with pay
day sick/vac. Without pay
Others (specify)-CSC MC 06s 1999
Special Privilege Leave - Dom. Emergency JAIME ARISTON G. YANOS
Inclusive dates from July 31 to August 1 & 2, 2013 Chief-EMD
to Approving Official
(To be indicated by the HRMO III)
DATE: July 16, 2013

PREAPRED BY:

EMMA B. BAYHON
Admin. Asst. III

Republic of the Philippines

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE REGIONAL DIRECTOR
Region IX, Zamboanga City
 Tel. No. 993-3000

APPLICATION FOR LEAVE

1. DIVISION/OFFICE 2. NAME (Last) (First) (Middle)

EMD CALUMBA FLORENCIO P.

3. Date of Filing 4. Position 5. Salary (No. Daily)

Oct. 9, 2013 Crafts & Trade Helper

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b.) WHERE LEAVE WILL BE SPENT

Vacation - E.O.1077 - FORCED LEAVE (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)

Otherss (specify) CSC MC 06S. 1999

Special Privilege Leave Out Patient (specify)

6. c) NUMBER OF WORKING DAYS APPLIED FOR: 6.d) COMMUTATION

1.000 working day- Requested Not Requested

INCLUSIVE DATES:
FLORENCIO P. CALUMBA
Signature of Applicant

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION

VAC. SICK
Approved
Bal. as of
Less: this application Disapproved due to
Net Balance

AMALIA Z. PATAGOC EFREN D. AQUINO

 Administrative Officer V Engineer III
Recommending Approval
7. c) APPROVED 7. d) DISAPPROVED DUE TO:
day Vacation Leave with pay
day sick/vac. Without pay
Others (specify)-CSC MC 06s 1999
Special Privilege Leave - Dom. Emergency JAIME ARISTON G. YANOS
Inclusive dates from Chief-EMD
to Approving Official
(To be indicated by the HRMO III)
DATE:

PREAPRED BY:
EMMA B. BAYHON
Admin. Asst. III
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE REGIONAL DIRECTOR
Equipment Management Division
Region IX, Tetuan, Zamboanga City

No. Regular Diesel Name of

Gasoline Plate No.
Type of VehiclesDriver Date Balance
Ltrs. ltrs. Ltrs.

OO1
OO2
OO3
OO4
OO5
OO6
OO7
OO8
OO9
O10
O11
O12
O13
O14
O15
O16
O17
O18
O19
O20
O21
O22
O23
O24
O25
O26
O27
O28
O29
O30
O31
O32
O33
O34
O35

PREPARED BY: APPROVED BY:

ELIZABETH R. LUSPO JAIME ARISTON G. YANOS

Clerk III Chief, Equipment Management Division
 Republic of the Philippines
Department of Public Works and Highways
OFFICE OF THE AREA EQUIPMENT ENGINEER
Area Equipment Section IX-03A
Ipil, Zamboanga Sibugay

EQUIPMENT SUPPLIED RENT FREE REPORT

For the ________________

NO. EQUIPMENT TYPE/MAKE/MODEL DPWH NO. PLATE NO. ERRO NO. PERIOD EQUIVALENT TO WHOM ISSUED AUTHORITY REMARKS
COVERED RENTALS

PREPARED BY: SUBMITTED BY:

 ROLAND E. HALOC LUDOVIC M. TANGON
Auto Equipment Inspector II Area Equipment Engineer