APPLICATION FOR LEAVE
(for CHED-CO Employees)
SC Form No.6
eee TD. NUMBER
1. OFFICE/AGENCY | 2. NAME (Last) (First) (Middle)
OMISSION ON HIGHER
EDUCATION . CENTRAL OFFICE
3. Date of Filing 4. Position 3. Salary (Monthly)
DETAILS OF APPLICATION
6._a) TYPE OF LEAVE b) WHERE LEAVE WILL BE SPENT
Vacation 1. INCASE OF VACATION LEAVE
To seek employment Within the Philippines
Others (specify) Abroad (Specify)
2. IN CASE OF SICK LEAVE
Sick In Hospital (Specify)
Maternity
Others (specify)
(Out Patient (Specify)
c) NUMBER OF DAYS APPLIED FOR:
d) COMMUTATION
INCLUSIVE DATES Requested >
Not Requested
(Signature of Applicant)
DETAILS OF ACTION ON APPLICATION
7.4) CERTIFICATION OF LEAVE CREDITS. b) RECOMMENDATION
AS OF Approval
Disapproval due to
‘Vacation Sick Total
Days Days Days
APOLONIA R. VIVO
Ciel, HROD, AFMS (Cifice Director)
c) APPROVED FOR: d) DISAPPROVED DUE TO:
Days with Pay
Days without pay
Others (specify)
(Signature)
ATTY. CINDERELLA FILIPINA S. BENITEZ-JARO
COffcer-in-Charge, Office ofthe Exeeutve Director
Director IV, LLS
Lemaire 218) 1800
(Date)