Name: Name:

Position: Position:
School/District: School/District:
Date: Date:

REQUIREMENTS FOR APPLICATION FOR LEAVE (SICK, REQUIREMENTS FOR APPLICATION FOR LEAVE TRAVEL
VACATION, MATERNITY) ABROAD (for Teachers)

 Application letter for leave  Application letter for leave

 Indorsement letter of school head  Indorsement letter of school head
 CSC Form 6  CSC Form 6 (Travel Abroad)
 Special Order  Form C
 Medical Certificate (CSC Form 41) for Sick and  Special Order (for 1 month and above only)
Maternity only  School Clearance from money and property
 Surgical procedure for RA 8291(magna carta for  CSC Form No. 7(clearance from money &
women property)
 School Clearance from money and Property  Certification of School Head (teacher who will
take over the class of the teachers who is on
**3 copies each leave)

Evaluated by: **4 copies each

Evaluated by:
 Name:
Name: Position:
Position: School/District:
School/District: Date:
Date:
REQUIREMENTS FOR APPLICATION FOR
REQUIREMENTS FOR APPLICATION FOR LEAVE TRAVEL REINSTATEMENT
ABROAD (for School Heads) (for Teachers)

 Application letter for leave  Application letter for reinstatement

 Indorsement letter of PSDS  Indorsement letter of School Head
 CSC Form 6 (Travel Abroad)  Special Order
 Special Order (for 1 month and above only)  Medical Certificate (CSC Form 86) for sick and
 District Clearance from money and property maternity leave only
 CSC Form No. 7(clearance from money &  Live birth of Child for maternity leave only
property)
 Certification of School Head (PSDS will take over **3 copies each
the school of the Schools Head who is on Leave)
Evaluated by:
**4 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

REQUIREMENTS FOR APPLICATION FOR REQUIREMENTS FOR APPLICATION FOR CHANGE OF

REINSTATEMENT CIVIL STATUS
(for School Heads)
 Application letter
 Application letter for reinstatement  Indorsement letter of School Head
 Indorsement letter of PSDS  Special Order
 Special Order  Marriage Contract (NSO) original and Photocopy
 Medical Certificate (CSC Form 86) for sick and
maternity leave only **3 copies each
 Live birth of Child for maternity leave only
Evaluated by:
**3 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR SUBSTITUTE POSITION SUPPORTING DOCUMENTS FOR RE-EMPLOYMENT

 Personal Data Sheet (PDS 2017 revised)
 Work Experience Sheet
 DBM_CSC Form 01 Job Description Form (2017
revised)
 Oath of Office CS Form 4 (2017 revised)
 Assumption to duty CS Form 32 (2017 revised)
 Form 211 (medical certificate for employment-
attach medical results except Neuro)
 NBI
 Marriage contract (for married women)
 Latest approved appointment if any (photocopy)
 Original Authenticated updated PRC license &
Board rating.
 Personal Data Sheet (PDS 2017 revised)
 Work Experience Sheet
 DBM_CSC Form 01 Job Description Form (2017
revised)
 Oath of Office CS Form 4 (2017 revised)
 Assumption to duty CS Form 32 (2017 revised)
 Latest approved appointment if any (photocopy)
 Original Authenticated updated PRC license &
Board rating.
**2 copies each
Evaluated by:

**2 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR ORIGINAL APPOINMENT SUPPORTING DOCUMENTS FOR PROMOTION

 Personal Data Sheet (PDS 2017 revised)
 Work Experience Sheet  Personal Data Sheet (PDS 2017 revised)
 DBM_CSC Form 01 Job Description Form (2017  Work Experience Sheet
revised)  DBM_CSC Form 01 Job Description Form (2017
 Form 211 (medical certificate for employment revised)
medical results)  CS Form 4 revised 2017 (Oath of Office)
 Blood Test  CS Form 32 revised 2017 (Assumption to Duty)
 Urinalysis  Neuro
 Chest X-ray  Latest Approved Appointment
 Drug Test  Updated PRC license & Board Rating
 Psychiatric Test(Neuro) (authenticated)
 Transcript of Records  Service Record
 Latest approved appointment if any (photocopy)  IPCRF (two rating periods)
 Updated PRC license & Board Rating
(authenticated) **2 copies each
 Sworn Statement of Asset and Liabilities (SALN)
 NBI Clearance Evaluated by:
 CS form 32 Revised 2017(assumption to duty)
 NSO Birth Certificate
 NSO Marriage Contract (for married Women)

**2 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR EQUIVALENT RECORD SUPPORTING DOCUMENTS FOR APPLICATION FOR
FORM (ERF) RETIREMENT

 Equivalent Record Form (ERF)  GSIS Retirement/ Insurance Form

 Sworn Statement  Non-Pendency form
 Original Transcript of Records (TOR)  SALN form
 Certificate of Authenticity from the School  Updated Service Record
Registrar  Original Policy Contract
 Updated Service Record  Clearance from money & property Responsibility
 Trainings (original certificate of participation if (school)
less than 33 units MA)  CS Form 7 (clearance form)
 Latest appointment
 IPRCRF **3 copies original
 PSIPOP 2 copies photocopy
 Latest Approved Appointment
Evaluated by:
**Note: Teacher III-33 units
Teacher II-24 units

**4 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR SALARY DIFFERENTIAL SUPPORTING DOCUMENTS FOR FIRST SALARY
FOR PROMOTION (PERMANENT)

 Certificate of assumption to duty  Certified Form 07 (report of service)

 Appointment (photocopy)  Daily Time Record
 Pay Slips before salary integration  Appointment (photocopy)
 Pay Slips after salary integration  Certificate of first day of service
 PSU form 01 (with employee no.)
**Note: Please wait for integration before submitting -Philhealth no.
documents -BIR Tin no.
-Pag-Ibig Mid no.
**3 copies each -GSIS BP no.
-Landbank Account no.
Evaluated by:  SALN
 Panunumpa sa Katungkulan (notarized)

**4 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR STEP INCREMENT SUPPORTING DOCUMENTS FOR SALARY DIFFERENTIAL
OF STEP INCREMENT
 Plantilla Allocation List
 Notice of Step Increment (NOSI)  Approved NOSI
 Latest appointment  Approved PAL
 Service Record (indicate leave of absence w/ &  Pay Slips before and after salary integration
w/o pay) (2 consecutive months)
 Latest Payslip  Service Record
 Latest Appointment
**4 copies each
*Note: Please wait for integration before resubmitting
Evaluated by: documents

**3 copies each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR FIRST SALARY SUPPORTING DOCUMENTS FOR SALARY INTEGRATION
(PROVISIONAL/CONTRACTUAL) (PERMANENT ONLY)

 Certified Form 07 (report of service)  Duly Accomplished PSU Form 1 with Employee
 Daily Time Record (DTR) no.
 Appointment  Appointment
 Certificate of first day of service  Certificate of first day of service
 PSU form 01 (without employee no.) **1 copy each
-Philhealth no.
-BIR Tin no. Evaluated by:
-Pag-Ibig Mid no.
-GSIS BP no.
-Landbank Account no.
 SALN
 Panunumpa sa Katungkulan

**4 copies each

Evaluated by:
Name:
Position:
School/District:
Date:

SUPPORTING DOCUMENTS FOR SALARY INTEGRATION

(for PROMOTION ONLY)

 Certificate of assumption to duty

 Appointment
 Latest Pay slip
**1 copy each

Evaluated by:
Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR STEP INCREMENT SUPPORTING DOCUMENTS FOR SALARY DIFFERENTIAL
OF STEP INCREMENT
 Plantilla Allocation List
 Notice of Step Increment (NOSI)  Approved NOSI
 Latest appointment  Approved PAL
 Service Record (indicate leave of absence w/ &  Pay Slips before and after salary integration
w/o pay) (2 consecutive months)
 Latest Payslip  Service Record
 Latest Appointment
**4 copies each
*Note: Please wait for integration before resubmitting
Evaluated by: documents

**3 copies each

Evaluated by:

Name: Name:
Position: Position:
School/District: School/District:
Date: Date:

SUPPORTING DOCUMENTS FOR STEP INCREMENT SUPPORTING DOCUMENTS FOR SALARY DIFFERENTIAL
OF STEP INCREMENT
 Plantilla Allocation List
 Notice of Step Increment (NOSI)  Approved NOSI
 Latest appointment  Approved PAL
 Service Record (indicate leave of absence w/ &  Pay Slips before and after salary integration
w/o pay) (2 consecutive months)
 Latest Payslip  Service Record
 Latest Appointment
**4 copies each
*Note: Please wait for integration before resubmitting
Evaluated by: documents

**3 copies each

Evaluated by:
Name:
Position:
School/District:
Date:

SUPPORTING DOCUMENTS FOR OVERTIME SERVICES

RENDERED
(for Non-Teaching, School Heads only)

 Request to render Compensatory Time Off

 Individual Accomplishment Report
 Daily Time Records (DTR)
 Special Order for earned CTOs
 Pictures

**2 copies each

Evaluated by: