APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/ AGENCY 2. Name (Last) (First) (Middle)

DEP-Ed – San Jose T. Reyes ES

3. DATE OF FILING 4. POSITION 5.SALARY (Monthly)

6. DETAILS OF APPLICATION

6. a.) Type of Leave 6. b) WHERE LEAVE WILL BE SPENT:

[ ] Vacation
[ / ] Sick
[ ] Personal
[ ] Maternity
[ ] Study
[ ] Others (Specify)………………………
……………………………………..
6. c.) NUMBER OF WORKING DAYS
APPLIED FOR: ________
INCLUSIVE DATES: _________
DETAILS OF ACTION ON APPLICATION
7. a.) CERTIFICATION OF LEAVE CREDITS
as of ……………………………………………….
1. IN CASE OF VACATION LEAVE
[ ] Within the Philippines
[ ] Abroad (Specify)………………………
………………………………………………
2. INCASE OF SICK LEAVE
[ ] In Hospital (Specify)…………………..
………………………………………………
[ ] Out Patient (Specify)………………….
………………………………………………
6. d.) COMMUTATION
[ ] Requested/ Not Requested
(Signature of Applicant)
7. b) RECOMMENDATION
[ ] Approval
[ ] Disapproval due to……………………

Vacation Sick Total

Days Days Days

RENATO M. ACERO
Human Resource Management Office CRISANTO C. MAGTALAS
Personnel Officer Principal

7.c.) APPROVED FOR: 7. d) DISAPPROVED DUE TO:

……………….days with pay ………………………………………
……………….days without pay ………………………………………
……………….others (specify) ……………………………………...

CARLITO D. ROCAFORT, CESO V

Schools Division Superintendent
(Authorized Official)

DATE: ……………………………