APPLICATION FOR LEAVE

C.S. Form 6
1. Office Agency :
2. NAME
(LAST)
(FIRST)
(M.I.)
DEP ED/ ROTONDA NHS
BUYA
LORLYN
S.
2. Date of Filing :
4. Position:
SALARY
(monthly)
October
,2015
Teacher I
18,549.00
DETAILS OF APPLICATION
6. Type of Leave
7. WHERE LEAVE WILL BE SPENT
___________Vacation
(1) In case of Vacation Leave:
___________To seek employment
________within the Philippines
___________Others (specify)_________________
________Abroad
(specify)___________
___________sick
_____/_____Maternity
(2) IN CASE OF SICK
LEAVE
________Hospital
(Specify)__________
________Outpatient
(Specify)_______
8. NUMBER OF DAYS APPLIED FOR
_________DAYS________
No. of Days

COMMUTATION

____________________________
Date of Leave

_______Requested ______Not Requested

CERTIFICATION OF LEAVE
:
Balance as of _________________
:
Service Credit: ____________
____________________________________
Leave:
______________
Balance: ______________
:
:
:
:
:
:

(Signature of Applicant)
C.S. Status: __Regular/Permanent____
Employee No. __
4642096_________
Mo. Salary:
P_18,549.00___________
Station No.
______________________
Division No. ______________________
Date of Original Appointment:
______________________

: Recommending Approval:

VENERANDO C. DELA
CRUZ
Principal
:

Certified Correct:
_____________

MARICRIS T. BABAR

RECOMMENDATION

:____________APPROVED _____________________
:___________DISAPPROVED DUE TO
:___________________________________________

Administrative Officer II

APPROVED FOR:
DISAPPROVED DUE TO:
__________________________
________days w/ pay
_____________________________________________
________days w/o pay
_____________________________________________
________others (specify)

LEONARDO M. BALALA

Asst. Schools Division Superintendent

Officer-in-Charge

Republika ng Pilipinas
Kagawaran ng Edukasyon
Rehiyon XII
Sangay ng Paaralang Lungsod
ROTONDA NATIONAL HIGH SCHOOL
City of Koronadal
Tel. No. (083)-228-7502