SC Form No.6 Revised 1984 HEPHEEEHEeEEEEEE ‘APPLICATION FOR LEAVE | 1. Office/Agency/School/District 2 Name (Last) First) (Middie) 3 Date of Filing 4. Position 5. Salary | | DETAILS OF APPLICATION 6. (2) TYRE OF LEAVE 6, (b) WHERE LEAVE WILL BE SPENT: (1) IN CASE OF VACATION LEAVE > VACATION Cl Within the Phitippines Toseek employment Ci Abroad (Specify) _ O others (2) INCASE OF SICK LEAVE O sick [In Hospital (Specify) O MaTeRNmry out Patient (Specify) 1 others (Specify) 6. (c) NUMBER OF WORKING DAYS APPLIED FOR 6. (4) COMMUTATION Ti Requested 1 Notrequested INCLUSIVE DATES (Signature of Applicant) 7. (a) CERTIFICATION OF LEAVE CREDITS 7. {b) RECOMMENDATION Asof, DD Approved Vacation Sick Total 1 Disepproved due to Days Days tae {Authorized Official) JOSE MARIANO E. BARI JR. ‘Admin. Officer IV/HRMO It 7) APPROVED FOR: 71a) DISAPPROVED OUE TO: days with pay ays without pay others (specify) RONELO AL K. FIRMO, Ph. D., CESO V Schools Division Superintendent