APPLICATION FOR LEAVE

CSC FORM NO. 6

1. AGENCY 2. NAME (LAST) (FIRST) (MIDDLE)
DepEd Cabanatuan City
3. Date of Filing: 4a) Employee No. 4b) Position 5a) Employment Status 5b) Monthly Salary

DETAILS OF APPLICATION
6a) TYPE OF LEAVE 6b) WHERE LEAVE WIL BE SPENT
_______________ To seek employment 1. In case of Vacation
______________ Vacation ________ within the Philippines
______________ Others (specify) _______ abroad (specify) ____________
________________________________ __________________________________
_______________ Maternity 2. In case of Sick Leave
_______________ Sick ________ in Hospital (specify) ________
_______________ Others (specify) ________ Out Patient (specify) ________
_______________ ________ Abroad (specify) ___________

6c) NUMBER OF WORKING DAYS 6d) COMMUTATION:

APPLIED FOR ________ ________ Requested
Inclusive Dates: _________________ Not Requested

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7b) CERTIFICATION OF LEAVE CREDITS AS OF
______________________________
7a) RECOMMENDATION
__________________ Approved Vacation: Sick: Total:
__________________ Disapproved due to No. of Leave Credits: : : :

Less this Leave: : : :

Immediate Supervisor Balance as of above: : : :

JOSANNA V. TOLEDO
Administrative Officer IV

7c) APROVED FOR: 7d) _____________________ APPROVED

______________ Days with pay _____________________ DISAPPROVED DUE TO
______________ Days without pay ___________________________________________
______________ Others (specify)
_____________________________

FERNANDINA P. OTCHENGCO, Ph.D

OIC Assistant Schools Division Superintendent
Division of Cabanatuan

For Teachers, SDO and school based non-teaching personnel