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)