Republic of the Philippines

DEPARTMENT OF EDUCATION
Region 02 (Cagayan Valley)
Schools Division of Isabela
ECHAGUE EAST DISTRICT
San Fabian, Echague

July 1, 2024
Date

The Schools Division Superintendent

DepED, Schools Division of Isabela
Alibagu, City of Ilagan, Isabela
(Thru Channels)

Madam:

I have the honor to request permission for a 105-day Maternity Leave with
pay from July 1, 2024 to , inclusive.

Attached are my pertinent papers relative hereto.

Hoping for your favorable consideration regarding my request.

Very truly yours,

HYDEE B. OLIVEROS
Teacher-1
Employee No. 0022495
Station No. 023-008
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02 (Cagayan Valley)
Schools Division of Isabela
ECHAGUE EAST DISTRICT
San Fabian, Echague, Isabela
CP No. 09065297672

DISTRICT CLEARANCE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that Ms HYDEE B. OLIVEROS, Teacher-1 of San

Miguel Elementary School, Echague East District, Echague, Isabela is cleared from all
money and property responsibilities.

This clearance is issued in connection with her application for maternity leave.

Issued this 1st day of July, 2024 at Echague, Isabela.

BARBARA G. ABAT MERY MAY E. IGNACIO

District Treasurer Administrative Officer-II/ Supply Officer

AMERPHIL R. RUDIO, EdD

Public Schools District Supervisor
 July 1, 2024
(Date)

DIVISION SPECIAL ORDER

No. s. 2024

SPECIAL ORDER FOR LEAVE OF ABSENCE

It is hereby made a matter of record that one National/Municipal Elementary

Grades Teacher in this division named below was granted 105-day Maternity Leave with
pay.

NAME: HYDEE B. OLIVEROS Employee Number: 0022495

DISTRICT: ECHAGUE EAST DIVISION: I S A B E L A

SERVICE RENDERED: 05/15/2013 to present (11 YRS.) ____________

ABSENCE WITHOUT PAY: NONE

EXPERIENCE AS PERMANENT: 05/15/2013 to present (11 YRS.) _______________

MONTHLY SALARY: P 29,865.00

***************************************************************************
Granted 105-day Maternity Leave with pay from May 15, 2023 to Aaugust 27, 2023,
inclusive.

***************************************************************************

BY AUTHORITY OF THE SECRETARY OF

DEPARTMENT OF EDUCATION:

RACHEL R. LLANA, PhD., CESO V

Schools Division Superintendent
C.S FORM 41
Republic of the Philippines
PHILIPPINE CIVIL SERVICE
MEDICAL CERTIFICATE

I hereby waive all rights and privileges pertaining to professional and

confidences between physician and patient, and the physician accomplishing this form is
authorized to answer all details and questions contained herein

HYDEE B. OLIVEROS
Signature of Patient
==================================================================
(N.B.) Attending Physician should fill in the blanks below. Every detail
should be answered to avoid delay in action on application for leave by the patient.

I, of
hereby certify that I was the applicant’s actual attending physician from
to inclusive, and from my professional knowledge of the
case, the following statements are submitted as contemplated by the Provision of Section 8 of
the Civil Service Rule XVI.
Nature of disease of disability:
Name of disease or disability:
==================================================================
PHYSIOLOGY: (Under this heading, in addition to giving fully the etiology of the disease or
disability, the physician must either state in the language of the Executive Order. “There are
no indications whatsoever that the disease named was due to immoral or vicious habits.”
___________________________________________________________________________
_________________________________________________________________________
HISTORY:
___________________________________________________________
DESCRIPTION: ____________________________________________________________
___________________________________________________________________________
A Laboratory Test or Examination in this case.
She expects to give birth on

The Applicant was confined in his/her hospital

from____________________________________ inclusive.
==================================================================
I hereby certify that the above statements are complete and true in every detail
and that in consequence of the disease or disability above specified, the applicant was ill and
unable to be on duty on account of illness from to
inclusive and that his/her claim is meritorious.

Affix Documentary Stamp Here Signature:

Name :
Title :

Date: