CSC Form No.

6
Revised 1984

APPLICATION FOR LEAVE

1. OFFICE AGENCY 2. NAME (LAST) (FIRST) (MIDDLE)

Deped DALGUNTAS DEBORAH BARRIENTOS
3. DATE OF FILING 4. POSITION / LEVEL 5. SALARY (MONTHLY)
October 24, 2019 Teacher III ₱ 25,232.00
DETAILS OF APPLICATIONS
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 (Please Specify) Abroad (Please Specify)

✔ SICK (2) IN CASE OF SICK LEAVE

MATERNITY ✔ In Hospital (Please Specify)
SPL Sindangan Community Hospital
Other (Please Specify) Out Patient (Please Specify)

6. (C) NUMBER OF WORKING DAYS 6. (D) COMMUTATION

APPLIED FOR 3 DAYS Requested
10/21/2019 to Not Requested
10/23/2019
DEBORAH B. DALGUNTAS
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. (A) CERTIFICATION OF LEAVE CREDITS 7. (B) RECOMMENDATION

As of For Approval
For Disapproval due to

VACATION: SICK: TOTAL:

Days Day Days

MANJOE L. TOLEDO
School Head

MA. MONINA L. PATOLTOL

HRMO

MARIA L. ARENAS
PSDS/EPS
7. (C) APPROVED FOR: 7. (D) DISAPPROVED DUE TO:
day/s with pay
day/s without pay
others (Please Specify)

ROSELLER N. GELIG, CESO VI

OIC - Schools Division Superintendent