APPLICATION FOR LEAVE

CSC FORM 6
Revised 1984
1. OFFICE/AGENCY

2. NAME: (LAST)

(FIRST)

DepEd- Naawan District

3. DATE OF FILING:
October 13, 2014

DE LOS REYES,SEVEN
4. POSITION:
HEAD TEACHER 1

MIDDLE)

MANDOAN
5. SALARY: ( Monthly)
23, 044.00

DETAILS ON APPLICATION
6. (A) TYPE OF LEAVE:

6. (B) WHERE LEAVE WILL BE SPENT

_______ Vacation Leave

_______ To seek Employment
_______ Others ( Specify) __________
_________________________________

1. IN CASE OF VACATION LEAVE:

________ Within the Philippines
__ _____ Abroad ( Specify) ____________
______________________________________

______ Sick
_______ Maternity
________________________
_______ Others ( Specify) ___________

2. IN CASE OF SICK LEAVE

________ In hospital ( Specify)
________ Out Patient ( Specify) _______________________

Number of Working Days Applied for:

(C.) COMMUTATION:

_________2____________________

______Requested

_______Not requested

Inclusive Date/s
_____October 7 8, 2014__________
_____________________
(Signature of Applicant)
DETAILS ON ACTION OF APPLICATION
7. (A) CERTIFICATION OF LEAVE CREDITS:

7. ( B.) RECOMMENDATION:

As of: ____________________________
Vacation

Sick

Total

Days

Days

Days

________ Approval
_______ Disapproval due to:
________________________

____________________________
(Personnel Officer)

NILDA M. MEJOS
PS- District Supervisor
(Authorized Official)

_______________________________________________________________________________________
8. (C.) APPROVED:

______ DAYS WITH PAY

______ DAYS WITHOUT PAY
______ OTHERS (SPECIFY)

9. (D) DISAPPROVED DUE TO:

_______________________________

__________________________________
(Signature)
_______________________
Date

CHERRY MAE L. LIMBACO, Ph.D., CESO V

(Authorized Official)