APPLICATION FOR LEAVE

CSC Form No. 6

9

DEPED-DAGUPAN CITY Employee NAME

No.
School: LAST FIRST MIDDLE

CARANGLAAN ES
Date of Filing:
A.) TYPE OF LEAVE
______ Vacation
______ To seek employment
______ Others (Specify)
___________________________
___________________________
___________________________
___/___ Sick
______ Maternity
______ Others (Specify)
___________________________
Position Title: Monthly Salary:
Php
B). WHERE WILL BE SPEND
IN CASE OF VACATION LEAVE:
( ) Within the Philippines
( ) Abroad (Specify)
IN CASE OF SICK LEAVE:
( ) In Hospital (Specify)___________________
( ) Out Patient (Specify) __________________

C.) NO. OF WORKING DAYS APPLIED FOR: __ day D.) Commutation

Inclusive Date(s): ( ) requested
( ) not requested

________________
Signature of Applicant

A. CERTIFICATION OF LEAVE CREDITS B.)RECOMMENDATION

As of _______________________ ( ) Approval
( ) Disapproved due to:
________________________________

Vacation Sick Total

JOHN SILVESTER A. ALIPIO,
Ph.D.
OIC-Principal

RECOMMENDING APPROVAL:

MYREL ANGELICA N. LOPEZ

Administrative Officer V

A.) APPROVED FOR: B. DISAPPROVED DUE TO:

_____________ Days with pay _____________________

_____________ Days without pay _____________________
_____________ Others (Specify) _____________________

APPROVED:
LORNA G. BUGAYONG, Ph. D., CESO VI
Schools Division Superintendent
1. Application for one (1) full day leave shall be made on this form.
2. Application for vacation leave shall be filled in advance or whenever possible five (5) days before going on such leave.
3. Application for sick leave, filled in advance, or exceeding in five (5) days shall be accompanied with a medical certificate. In case medical consultation was
not availed then an affidavit should be executed by the applicant.
4. An employee who is absent without an approved leave shall not receive his/her salary corresponding to the period of unauthorized leave of absence.
5. An application for thirty (30) calendar days or more of leave of absence shall be accompanied with a clearance from financial and property accountabilities.