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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
Schools Division of Zamboangadel Norte
KATIPUNAN I DISTRICT

PERTINENT PAPERS
of
Augie Ribe V. Labucay
MACAYAS ELEMENTARY SCHOOL,
BALOK, KATIPUNAN, ZAMBO. NORTE

for

REINSTATEMENT

from

Maternity Leave
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL NORTE
KATIPUNAN I DISTRICT

2nd Endorsement

____________________________

Respectfully forwarded to the Schools Division Superintendent, Division of Zamboanga


del Norte, Dipolog City, the herein pertinent papers of Ms. Augie Ribe V. Labucay, Regular/Permanent
Teacher I of Macayas Elementary School as an application for MATERNITY LEAVE, recommending for
approval.

SILVIANO S. ANDIG
ESHT-III
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL NORTE
KATIPUNAN I DISTRICT

2nd Endorsement

____________________________

Respectfully forwarded to the Schools Division Superintendent, Division of Zamboanga


del Norte, Dipolog City, the herein pertinent papers of Ms. Augie Ribe V. Labucay, Regular/Permanent
Teacher I of Macayas Elementary School as an application for MATERNITY LEAVE, recommending for
approval.

SILVIANO S. ANDIG
ESHT-III
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL NORTE
KATIPUNAN I DISTRICT

1st Endorsement

____________________________

Respectfully forwarded to the Schools Division Superintendent, Division of


Zamboanga del Norte, Dipolog City, the herein pertinent papers of Ms. Augie Ribe V. Labucay,
Regular/Permanent Teacher I of Macayas Elementary School as an application for MATERNITY
LEAVE, recommending for approval.

SILVIANO S. ANDIG
ESHT-III
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL NORTE
KATIPUNAN I DISTRICT

1st Endorsement

____________________________

Respectfully forwarded to the Schools Division Superintendent, Division of


Zamboanga del Norte, Dipolog City, the herein pertinent papers of Ms. Augie Ribe V. Labucay,
Regular/Permanent Teacher I of Macayas Elementary School as an application for MATERNITY
LEAVE, recommending for approval.

SILVIANO S. ANDIG
ESHT-III
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL NORTE
KATIPUNAN I DISTRICT
MACAYAS ELEMENTARY SCHOOL

PEDRO MELCHOR M. NATIVIDAD, CSEE


Schools Division Superintendent
Zamboanga del Norte Division
Dipolog City

Sir:

Greetings!

I have the honor to apply for REINSTATEMENT as Teacher-I of Macayas Elementary School after a
60-day Maternity Leave of Absence without pay effective from _____________________ to
_____________, 2017.

Attached herewith are the supporting documents to wit;

1. Questionnaire after delivery


2. Medical Certificate showing physically fit
3. Birth Certificate of the Child (if applicable)

Respectfully yours,

AUGIE RIBE V. LABUCAY


Teacher-I
1st Endorsement
MACAYAS ELEMENTARY SCHOOL

____________________________

Respectfully forwarded to the Schools Division Superintendent, Division of Zamboanga del Norte,
Dipolog City, the herein application letter of AUGIE RIBE V. LABUCAY, Regular/Permanent Teacher I of
Macayas Elementary School for REINSTATEMENT.

Recommending for approval.

SILVIANO S. ANDIG
ESHT-III
Enclosure No. 2 to Division Circular No. 4 s. 1955

QUESTIONNAIRE TO BE ANSWERED BEFORE DELIVERY

1. Date of Marriage: N/A


2. Last Day of Menstruation: December 10, 2016
3. (a) Pre-natal care given by: Dr. Rosemarie Dublin
(b) How many times did you examined for pre-natal: Every month starting from pregnancy.
(c) Date of last examination: September 2, 2017
(d) Who examined? Dr. Rosemarie Dublin
4. Blood pressure: Date taken:
5. Urine examined: Date taken:
6. Other abnormalities:

7. No. Of previous pregnancies: 0


8. Did you have any difficult delivery? If so, state:
9. Date of effectivity of pregnant maternity leave:
10. Where did you intend to call to assist your delivery?

I HEREBY CERTIFY under oath that the answers to the foregoing questions are true and correct.

AUGIE RIBE V. LABUCAY


Teacher-I

SUBSCRIBED AND SWORN to before me this ________ day of ________________, 2017 at


______________________________________ Zamboanga del Norte.

_____________________
Designation
Enclosure No. 2 to Division Circular No. 4 s. 1955

QUESTIONNAIRE TO BE ANSWERED BEFORE DELIVERY

1. Date of Marraige: N/A


2. Last Day of Menstruation: December 10, 2016
3. (a) Pre-natal care given by: Dr. Rosemarie Dublin
(b) How many times did you examined for pre-natal: Every month starting from pregnancy.
(c) Date of last examination: September 2, 2017
(d) Who examined? Dr. Rosemarie Dublin
4. Blood pressure: Date taken:
5. Urine examined: Date taken:
6. Other abnormalities:

8. No. Of previous pregnancies: 0


8. Did you have anny difficult delivery? If so, state:
9. Date of effectivity of pregnant maternity leave:
11. Where did you intend to call to assist your delivery?

I HEREBY CERTIFY under oath that the answers to the foregoing questions are true and correct.

AUGIE RIBE V. LABUCAY


Teacher-I

SUBSCRIBED AND SWORN to before me this ________ day of ________________, 2017 at


______________________________________ Zamboanga del Norte.

_____________________
Designation
CSC Form No. 6

APPLICATION FOR LEAVE

1. Office /Agency 2. Name: (Last) (First) (Middle)


MACAYAS ES /
DEP. ED.-ZAMBO.NORTE LABUCAY AUGIE RIBE VALLECER

3. Date of Filing: 4. Position: 5. Monthly Salary


TEACHER-I Php 19,620.00

DETAILS OF APPLICATION

6. a) Type of Leave: 6. b) Where will leave be spent?


( ) Vacation 1) In case of Vacation Leave
( ) To seek Employment ( ) Within the Philippines
( ) Other (Specify) ( ) Abroad (Specify)

2) In case of Sick Leave


( ) Sick ( ) In the Hospital
( / ) Maternity
( ) Other (Specify) ( ) Out Patient(Specify)

6. d) Computation
6.c) Number of Working Days Applied for: 60 days ( ) Requested ( ) Not Requested
Inclusive Dates:
_______________
Signature of Applicant

Employee No: 1700312 Station Code: 005

DETAILS OF ACTION OF APPLICATION

7. a) Certification of Leave Credits 7. b) Recommendation:


As of: ( ) Approved
( ) Disapproved due to:

Vacation Sick Total

Days Days Days

SILVIANO S. ANDIG
HEIDI D. SALAC Elementary School Head Teacher-III
HRMO-Administrative Officer II

7. c) Approved for 7. d) Disapproved due to:


______ Days with pay
______ Days without pay
______ Other (Specify)

Date:

PEDRO MELCHOR M. NATIVIDAD, CSEE


Officer-In-Charge
Office of the Schools Division Superintendent
Enclosure No. 2 to Division Circular No. 4 s. 1955

QUESTIONNAIRE TO BE ANSWERED AFTER DELIVERY

1. Date of Delivery: ________________________________________________________________________

2. Sex of the baby: _________________________________________________________________________

3. Weight of the baby after birth: ______________________________________________________________


4. Height of the baby immediately after birth:____________________________________________________
5. Condition of the baby immediately after birth:__________________________________________________
6. Condition of the mother immediately after birth:________________________________________________

7. Who attended the delivery? ________________________________________________________________


8. Was the delivery normal or abnormal? _______________________________________________________
9. Details: ________________________________________________________________________________
________________________________________________________________________________

(This questionnaire is accomplished by a certificate of the person who attended to the delivery, stating the nature of the said delivery
and condition of the baby immediately after birth.)

I HEREBY CERTIFY under oath that the answers to the foregoing questions are true and correct.

AUGIE RIBE V. LABUCAY


Teacher-I

SUBSCRIBED AND SWORN to before me this ________ day of ________________, 2017 at


______________________________________ Zamboanga del Norte.

_____________________
Designation
Enclosure No. 2 to Division Circular No. 4 s. 1955

QUESTIONNAIRE TO BE ANSWERED AFTER DELIVERY

1. Date of Delivery: ________________________________________________________________________

2. Sex of the baby: _________________________________________________________________________

3. Weight of the baby after birth: ______________________________________________________________


4. Height of the baby immediately after birth:____________________________________________________
5. Condition of the baby immediately after birth:__________________________________________________
6. Condition of the mother immediately after birth:________________________________________________

7. Who attended the delivery? ________________________________________________________________


8. Was the delivery normal or abnormal? _______________________________________________________
9. Details: ________________________________________________________________________________
________________________________________________________________________________

(This questionnaire is accomplished by a certificate of the person who attended to the delivery, stating the nature of the said delivery
and condition of the baby immediately after birth.)

I HEREBY CERTIFY under oath that the answers to the foregoing questions are true and correct.

AUGIE RIBE V. LABUCAY


Teacher-I

SUBSCRIBED AND SWORN to before me this ________ day of ________________, 2017 at


______________________________________ Zamboanga del Norte.

_____________________
Designation