APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

DepEd, Pasay City

3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

6. DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT:
Vacation 1. IN CASE OF VACATION LEAVE
Sick Within the Philippines
Personal Abroad (Specify) .......................................
Maternity
Study …....................................................................
Others (Specify) ___ ___ ____ 2. IN CASE OF SICK LEAVE
......................................................... In Hospital (Specify) ..................................
6. c) NUMBER OF WORKING DAYS ........................................................................
APPLIED FOR ................................... Out Patient (Specify) ..................................
.............................................................. ........................................................................
6. d) COMMUTATION
INCLUSIVE DATES............................ Requested Not Requested
..............................................................
......................................................
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
Approval
as of ............................................................ Disapproval due to .......................................

Vacation Sick Total

Days Days Days EVANGELINE P. LADINES, CESO VI

Schools Division Superintendent
............................................
(Personnel Officer)
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:
................... days with pay
................... days without pay .............................................................
................... others (Specify) ............................................................

____________________________
(Signature)

..................................................................
(Authorized Official)
Date: .............................