Department of Education

Region V
DIVISION OF CAMARINES SUR
Freedom Sports Complex, San Jose, Pili, Camarines Sur

APPLICATION FOR LEAVE

SC Form No. 6

OFFICE/AGENCY LAST NAME FIRST NAME MIDDLE NAME

DATE OF FILING POSITION SALARY (MONTHLY)

DETAILS OF APPLICATION

A) TYPE OF LEAVE B) WHERE LEAVE WILL BE SPENT

Vacation (1) In case of Vacation Leave

To seek Employment Within the Philippines

Sick Leave Abroad (Specify)

Maternity (2) In case of Sick Leave

Other (Specify) Name of Hospital

Out Patient (Specify)

C) NUMBER OF WORKING DAYS D) COMMUTATION

APPLIED FOR Requested

INCLUSIVE DATES Not Requested

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

A) CERTIFICATION OF LEAVE CREDITS B) RECOMMENDATION

as of

Vacation Sick Total COC SPL Approved

LESS : This Leave Disapproved due to

Balance

Head of Agency
MARIA DIVINA H. CALLEJA
Personnel Section

C) APPROVED FOR D) DISAPPROVED DUE TO

days with pay
days without pay
other (specify)