STUDY LEAVE CONTRACT

KNOW ALL MEN BY THESE PRESENTS:

This Study Leave Contract Contract is made and entered into, by and between:

_____________________________________________
_____________________________________________
_____________________________________________,
hereinafter referred to as the AGENCY

-and-

_____________________, of legal age, Filipino, a

permanent employee of the ______________________,
holding the position of ___________________________
with office address at ____________________________,
hereinafter referred to as the BENEFICIARY;

WITNESSETH: THAT -

Whereas, Civil Service Commission (CSC) Memorandum Circular No. 21, s. 2004,
otherwise known as Amendment to Section 68 of CSC MC No. 14, s. 1999 relative the
Guidelines on Study Leave provides that officials and employees, excluding those in the
teaching profession who are covered by different provisions of law, may be entitled to go on
study leave on official time to prepare for their bar/board examinations or complete their
masters degree;

Whereas, the BENEFICIARY is requesting to avail the study leave privilege afore-
mentioned in order to complete her degree of Master of Science in ______________ at the
____________________________ for a period of _____ (__) months;

Whereas, the BENEFICIARY is qualified to avail the Study Leave Program pursuant to
the above-mentioned CSC guidelines on Study Leave;

NOW, THEREFORE, for and in consideration of the foregoing premises and of the terms
and conditions hereunder stipulated, the PARTIES hereby agree as follows:

I. The BENEFICIARY shall:

1. Avail of the study leave to complete her _______________ masters degree on

a full time basis for a period of ______ (__) months on official time provided
that she has met the following requirements to wit:

1.1 The field of study to be pursued is relevant to the duties and responsibilities
as a _____________________ in __________;

1.2 Has rendered at least two (2) years of service with at least very satisfactory
performance for the last two (2) rating periods immediately preceding her
application for Study Leave;

1.3 Has no pending administrative and/or criminal charges;

1.4 Has no current foreign or local scholarship grant;

1.5 Has a permanent appointment or in case of a coterminous appointment,

has satisfy the requirements under items 1.1 to 1.4 hereof and would be able
to fulfill the required service obligation and is not related to the agency head
within the 4th degree of affinity or consanguinity;
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Study Leave Contract
between the ____________________________

2. Finish the study leave within the prescribed period without further extension;

3. Furnish the Human Resource Management Office (HRMO) with the copy of the
contract for study leave;

4. Submit a written notice of return to work to HRMO upon completion of the

study leave;

5. Report to work immediately upon completion of the study leave;

6. Fulfill ____ (___) year/s service obligation to the AGENCY;

7. Refund the gross amount of salary, allowances and other benefits received while
on study leave proportionate to the balance of the service obligation required in
case the BENEFICIARY has failed to render in full the required service
obligation on account of voluntary resignation, optional retirement, separation
from the service through her own fault, or other causes within her control;

8. Refund to the AGENCY all the salaries and benefits received during the study
leave in case the BENEFICIARY has failed to complete her applied nutrition
masters degree.

II. The AGENCY shall:

1. Exercise full discretion in authorizing the BENEFICIARY to complete her

masters degree for a period of ________ (__) months

2. Relieve the BENEFICIARY of all her duties and responsibilities as

__________________________ for the duration of the study leave;

3. Pay the salary and all authorized allowances or benefits of the BENEFICIARY;

4. Credit as continuous service the period of the study leave of the BENEFICIARY;

5. Effect the refund of salary, allowances and other benefits received by the
BENEFICIARY while on study leave for violation of the terms and conditions of
this contract.

IN WITNESS WHEREOF, the PARTIES hereto, affix their respective signatures this
__________________ at ______________, Philippines.

AGENCY
By:

__________________________

BENEFICIARY

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Study Leave Contract
between the ____________________________

Signed in the presence of:

___________________________ _________________________
Witness Witness

ACKNOWLEDGMENT

Republic of the Philippines}

. } S.S.

BEFORE ME, a Notary Public for and in the above place and jurisdiction, this ___ day of
__________________ 2017, personally appeared the following:

Name Valid ID

____________________________ ____________________________

____________________________ ____________________________

Both known to me and to me known to be the same persons who executed the foregoing
document and they acknowledged that the same is their own free will and voluntary act and
deed.

This document which refers to a Study Leave Contract consists of three (3) pages
including this Acknowledgment, signed on each and every page thereof by the parties thereto
and their two (2) instrumental witnesses.

WITNESS MY HAND AND SEAL, on the date and at the place above-mentioned.

NOTARY PUBLIC

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 201__.