CSC Form No.

6 (Revised 1984)

APPLICATION FOR LEAVE

SCHOOL PERSONNEL
1. NAME OF SCHOOL 2. (LAST NAME) (FIRST NAME) (MIDDLE)

3. DATE OF FILLING 4. A. POSITION 4. B. EMPLOYEE NUMBER 5. SALARY (MONTHLY)

DETAILS OF APPLICATION
6. A. TYPE OF LEAVE 6. B. WHERE LEAVE WILL BE SPENT
________________ Vacation * In case of vacation leave
To seek employment Within the Philippines
Others (Specify) Abroad (Specify)
Sick * In case of Sick Leave
Maternity In Hospital (Specify)
Others ( Specify) Out Patient ( Specify)
6. C. Number of Working Days Applied for: _________ 6. D. COMMUTATION

Inclusive Dates______________ Requested Not Requested

Recommending Approval:

HERNANI P. ESPERAT _____________________________________________

School Head Applicant

DETAILS OF ACTION ON APPLICATION

7. A. CERTIFICATION OF LEAVE CREDITS 7. B. RECOMMENDATION FOR:
as of: ______________________________________________
Vacation Sick Total Approval

Disapproval due to _______________

Days Days Days

DULCE ELAINE S. TORRES AL-RAHIMIN T. KENOH

Administrative Officer IV Administrative Officer V
7. C. APPROVED FOR: DISAPPROVED DUE TO: _________________________
_______________ Days with Pay ____________________________________________
_______________ Days without Pay ____________________________________________
_______________ Others (Specify)

FELIX ROMY A. TRIAMBULO, CESE

Assistant Schools Division Superintendent
OIC – Office of the Schools Division Superintendent
INSTRUCTIONS:
1. Application for Vacation or Sick Leave for one (1) full COMPUTATION OF LEAVE OF CREDITS
Day shall be made on the Form and to be accomplished
in duplicate.
2. Application for Vacation Leave shall be filed in advance VACATION LEAVE SICK LEAVE
or whenever possible five (5) Days before going on Balance as of:
such leave.
3. Application for Sick Leave filed in advance or Leave earned
exceeding five (5) Days shall be accomplished by from:
Medical Certificate. In case medical consultation were Total Leave
not availed of. An affidavit should be excused by the
applicant. Credits as of:
4. An Employee who is absent without approved leave Less this Leave:
shall not be entitled to receive his/her salary
corresponding the period of his/her unauthorized Balance still due
leave of absence. as of:
5. An application for leave of absence for Thirty (30)
Calendar Days or more shall be accompanied by a Certified Correct:
clearance from money and property accountabilities.