Professional Documents
Culture Documents
Leave Form 6
Leave Form 6
Leave Form 6
Region V
Division of Camarines Sur
DEL GALLEGO DISTRICT
Nov.22,2018
Date
MADAM:
I have the honor to apply for Two ________( 2 ) ______ Working Days
I further request that my leave of absence be offset by the following duly earned service credits,
to wit;
____________________________________________________________________________________
Approved:
MARCELA R. COLLANTES
Head Teacher 1
Department of Education
Region V
Division of Camarines Sur
DEL GALLEGO DISTRICT
PAPERS FOR
REINSTATEMENT
Department of Education
Region V
Division of Camarines Sur
DEL GALLEGO DISTRICT
November 26,2018
Date
MAdam:
I have the honor to apply for reinstatement to service effective November 26,2018
________________________________________________.
Approved:
MARCELA R. COLLANTES
Head Teacher 1
Form 6
DETAILS OF APPLICATION
Maternity In Hospital
____________________ _______________________
As of ____________________________ APPROVED
Vacation Sick Total DISAPPROVED DUE TO
_________________________
7. (c) APPROVED:
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INSTRUCTIONS
Applicant for vacation or sick leave for one full dayor more shall made on this form and accomplished at least in duplicate.
Application for vacation leave shall be filed in advance or whenever possible five (5) shall be accompanied by medical
certificate. In caseof Medicalconsultationwas not availed of an affidavit should be executed by applicant.
An employee who is absent without approved leave shall not be entitled to received her/his salary corresponding to the
period of his/her unauthorized leave of absence.
An applicant for leave of absence for thirty (30) calendar days or more shall accompanied by clearance for money and property
responsibilities
C.S.C Form 41
_____________________________
Signature of the Patient
(F.B) Attending physician should fill in the blanks below. Every detail should answer to avoid
delay in action on application for leave submitted by the patient.
Department of Education
Region V
Division of Camarines Sur
DEL GALLEGO DISTRICT
_______________________
Date
CERTIFICATION
TO WHOM IT MAY CONCERN
This is to certify____________________________________, _____________________
Of this school and/ or district has been cleared of all money and property responsibility in this
school/district as of today______________________________, thus (X) COMPLETE
CLEARANCE in this school/district is hereby granted. Consequently, turnover of property and
Responsibility has been accordingly made to his /her successor in the services.(In case of Head
Of school/District Supervisor/Chief cluster Principal, an invoice Receipt for property turnover
is required ,However , the above mentioned person has completely accounted for all
Governmentproperty received by him/her during his/her tenure of service in this school/district.
___________________________________________
Name and Signature of Person Seeking Clearance
CS FORM 211
MEDICAL CERTIFICATE
For employment
PHILIPPINE SERVICECOMMISION
I N S T R UC T I O N S
1. This medical certificate should be accomplished by a government physician.
2. Attached this certificate to original appointments and reinstatements.
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NAME ( Last, First, Middle if married woman :AGENCY:
give her maiden name) :__________________________________
_______________________________________ :__________________________________
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ADDRESS: _______________________________ : PROPOSED POSITION:
_________________________________________: ________________________
AGE: ____ SEX: ____CIVIL STATUS: __________
______________________________________________________________________________
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SIGNATURE OF PHYSICIAN : CERTIFICATE NUMBER : OTHER INFORMATION
: : ABOUT THE APPOINTEE
: :
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