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CSC Form 6

Revised 1998

APPLICATION FOR LEAVE


1. Office/Agency 2. Name (Last) (First) (Middle)
Department of Education Tigaon District Quinones Joan Atole
3. Date of Filing 4. Position 5. Salary
January 31,2018 Teacher I Php 19,620.00
DETAILS OF APPLICATION
6. A) Type of Leave 6. B) Where Leave will be spent:
Vacation 1. In case of Vacation Leave
To seek employment Within the Philippines
Others (Specify) Abroad (Specify)

/ Sick 2. In case of Sick Leave


Maternity In hospital (Specify)
Others (Specify)

6. C) Number of Working Days applied for: 6. D) Commutation


One (1)working day / Requeste Not Requested
Inclusive Dates
###
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as oOne (1) day working days

Vacation Sick Total / Approval


1 1 Disapproval due to
days days days

Authorized Official Authorized Official


7. C) Approved for: 7. D) Disapproved due to:
1 days with pay
days without pay

Signature

Authorized Official
Date: January 31, 2018
Requested