APPLICATION FOR LEAVE

CSC Form No. 6 Revised 1984

1.

3.

OFFICE/AGENCY DepEd Division of Ilocos Norte DATE OF FILLING 9/12/2011

2. LAST NAME MELAD 4. POSITION TEACHER III

FIRST CELESTE

MIDDLE MUNDOY 5. SALARY (MONTHLY) P 19,908.00

DETAILS OF APPLICATION
6. a). TYPE OF LEAVE Vacation To seek employment Others (specify) Sick / Maternity Others (specify) 6. c). Number of Working Days applied for: 60 Days Inclusive dates October 10, 2011 December 10, 2011 6. b). WHERE LEAVE WILL BE SPENT In case of Vacation Leave Within the Philippines Abroad (specify) In caseof Sick Leave -- In Hospital (specify) -- Out Patient (specify) 6. d). COMMUTATION Requested Not requested

CELESTE M. MELAD Signature of Applicant

DETAILS OF ACTION ON APPLICANT

7. a). CERTIFICATION OF LEAVE CREDITS as of Vacation Sick Total 7. b). RECOMMENDATION

Approved Disapproved due to

Days

Days

Days FELY G. CARIO, Ed.D. Public Schools District Supervisor Authorized Official

MA. DULCE B. CALIJA Administrative Officer V 7. c). APPROVED FOR: days w/ pay days w/o pay others (specify)

7. d). DISAPPROVED DUE TO:

Signature

Date

CECILIA P. ARIBUABO, CEO IV School Division Superintendent Authorized Official

(MONTHLY) ,908.00

equested

MELAD pplicant

O, Ed.D. rict Supervisor Official