Republic of the Philippines
DEPARTMENT OF EDUCATION
CARAGA Administrative Region
Division of Surigao del Sur
SAN MIGUEL I DISTRICT
_________________________________________________________________________________________________________________________________
September 5, 2022
JOSITA B. CARMEN, CESO V
Schools Division Superintendent
Division of Surigao del Sur
Tandag City
Madam:
May I have the honor to return to work as Elementary Teacher III of Catabadan Elementary School-San
Miguel I District effective September 12, 2022. I was on MATERNITY LEAVE with 105 DAYS WITH FULL PAY from
May 30, 2022 to September 11, 2022 inclusive.
Attached herewith are my supporting documents such as Request for Reinstatement (PSU Form 109), and
Medical Certificate (CS Form 211 ) and Certificate of Live Birth (Form 102) of my child, for your perusal.
Very truly yours,
DONNA C. CANNEN
Teacher –I/CATABADAN ES
2nd ENDORSEMENT
___________________
San Miguel, Surigao del Sur
Respectfully forwarded to the Schools Division Superintendent, Tandag, Surigao del Sur (Thru Channel)
inviting attention for REINSTATEMENT TO DUTY from MATERNITY LEAVE with 105 DAYS WITH FULL PAY of DONNA
C. CANNEN , Teacher of Libas Sud Integrated School, San Miguel I District effective September 12, 2022 and
recommending favorable action.
.
Very truly yours,
JENNIFER B. MOLDEZ
SCHOOL HEAD
RECOMMENDING APPROVAL:
APPROVED:
NORBEN T. MOLDEZ, Ed.D
Schools District Supervisor
JOSITA B. CARMEN, CESO V
Schools Division Superintendent
Republic of the Philippines
DEPARTMENT OF EDUCATION
CARAGA Administrative Region
Division of Surigao del Sur
SAN MIGUEL I DISTRICT
_________________________________________________________________________________________________________________________________
REQUEST FOR REINSTATEMENT
Division Name / Code
Station Name
Station Code
Employee Number
Complete Name
Date of Approved Reinstatement
: SURIGAO DEL SUR / 072
: San Miguel I District
: 041
:
: DONNA C. CANNEN
: September 12, 2022
Attached Working Papers/ Requirements:
1.
2.
3.
4.
Original Copy of Reinstatement duly approved by the Superintendent.
Special Order signed by the Superintendent (PSU Form 9-A)
Medical Certificate / CS Form 41 Orig. ( if reinstatement is from Maternity Leave)
Medical Certificate / CS Form 211 Orig. ( if reinstatement is from SL, VL & others)
Inclusive Period of Leave :
MAY 30, 2022
From
SEPTEMBER 11, 2022
To
Check ( / ) (Kind of Leave)
Sick Leave (SL)
_______
Vacation Leave (VL)
Personal Leave (PL)
_______
Maternity Leave (ML) ___/___
Force Leave (FL)
_______
Other, specify :
Please check appropriate box
w/ pay
______
_____
w/out pay
Last Paycheck received (prior to leave)
______________________
(mm/ dd/ yy)
Paycheck returned if any (indicate month)
______________________
For ML with full or half pay, please specify if
(Please check appropriate box)
consumed 60 days
not consumed 60 days
PSU REMARKS:
__________________________________________________________________________________________
____________________________________________________________
Approved:
NORBEN T. MOLDEZ
Schools District Supervisor
Republic of the Philippines
DEPARTMENT OF EDUCATION
CARAGA Administrative Region
Division of Surigao del Sur
SAN MIGUEL I DISTRICT
_________________________________________________________________________________________________________________________________