CSC Form No.

Department of Education
Region X
DIVISION OF CAGAYAN DE ORO CITY
Cagayan de Oro City

APPLICATION FOR LEAVE

1 OFFICE/AGENCY 2 NAME: (LAST) (FIRST) (M.I.)

Dep ED Division of Cagayan de Oro City
First Legislative
Taglimao National High School-Tumpagon Annex
3 DATE OF FILING 4 POSITION 5 MONTHLY SALARY

6 A.) TYPE OF LEAVE 6 B.) WHERE LEAVE BE SPENT

______ Vacation
______ To seek employment 1) IN CASE OF VACATION LEAVE
______ Sick leave ______ Within the Philippines
______ Maternity ______ Abroad (Specify)
______ Others (Specify) ___________
________________________
2) IN CASE OF SICK LEAVE
6 C.) NUMBER OF WORKING DAYS APPLIED ______ in Hospital (Specify)
______ Day ____________
______ Out Patient (Specify)
INCLUSIVE DATES ____________
____________________________
6 D.) COMMUTATION
______ Requested ______ Not Requested

7 A.) CERTIFICATION OF LEAVE CREDITS
As of _____________________
_____________________
_____________________
_____________________
_______________________
Signature of Applicant
7 B.) RECOMMENDATION
______ Approved
______ Disapproved due to
______________________
______________________

Vacation Sick TOTAL

Days Days Days JUDSON M.PASTRANO

_________________________________
(Personnel Officer)
7 C.) APPROVED FOR:
_______ Days with Pay
_______ Days without Pay
_______ Others (Specify)
Secondary School Principal I
7 D.) DISAPPROVED DUE TO
_______________________
_______________________
_______________________

Date: ________________ ______________

Signature

___________________________
Authorized Official