CSC FORM 6

Revised 1998 APPLICATION FOR LEAVE

1. OFFICE/AGENCY: 2. NAME: (Last) (First) (Middle)
DepED,Villa Cacho Integrated School GALANG NOIMIE CABANSAG

3. DATE OF FILLING 4. POSITION: 5. SALARY

Head Teacher I 26, 494.00 ____________

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) 50% MONETIZATION / / Abroad (Specify):

_____________________________________________________________________________________
(2.) IN CASE OF SICK LEAVE
/ / In hospital (Specify)

/ / Sick

/ / Maternity

/ / Others (Specify)
_____________________________________________________________________________________
6. (C.) NUMBER OF DAYS APPLIED FOR: 6. (D.) COMMUTATION:
Applied for:_____________________________ / / Requested
Inclusive Date: __________________________ / / Not requested

_______________________________
Applicant’s Signature

DETAILS OF ACTION ON APPLICATION

______________________________________________________________________________
7. (A.) CERTIFICATE OF LEAVE CREDITS 7. (B.) RECOMMENDATION

As of / / Approved:
Vacation Sick Total / / Disapproved due to ______
/ / / / / /
Days Days Days

LOU JANE M. NICOLAS SONNY T. DALIT

Administrative Officer IV Head Teacher III

7. (C.) APPROVED FOR: 7. (D.) DISAPPROVED DUE TO:

Days with pay

Days without pay
Others (Specify)

JESSIE L. AMIN, CESO V

Schools Division Superintendent