Region VIII
DIVISION OF SAMAR
Catbalogan City
_____________________________________________________________________________
APPLICATION FOR LEAVE
CSC Form 6
(Revised 1998)
1. Office / Agency Employee/ID number:______________________________
DepED – Division of Samar School / Office: ______________________________
District: ______________________________
Employee Contact Number:_________________________
2. Name_____________________________________________________________________________________
(Last Name) (First Name) (Middle Name)