A P P L I C A T I O N FOR L E A V E

CS Form No. 6
Revised 1994

1. OFFICE/AGENCY 2. NAME: (Last) (First) (Middle)

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

DETAILS OF APPLICATION

6a. TYPE OF LEAVE 6b. WHERE WILL BE SPEND

( ) VACATION IN CASE OF VACATION LEAVE:
( ) To seek employment ( ) Within the Philippines
( ) Others (specify) ( ) Abroad (Specify)
______________________________
______________________________
IN CASE OF SICK LEAVE:
( ) SICK ( ) In Hospital (Specify)___________________
( ) MATERNITY ( ) Out Patient (Specify) __________________
( ) Others (Specify)
_______________________________

6c. NO OF WORKING DAYS APPLIED FOR: d. COMMUTATION

_________________________ ( ) Requested
( ) Not Requested
INCLUSIVE DATES:
_______________________
(Signature of Applicant)

Employee No.______________

DETAILS OF ACTION OF APPLICATION

7a. CERTIFICATION OF LEAVE CREDITS 7b. RECOMMENDATION

As of _______________________ ( ) Approved
( ) Disapproved due to:
Vacation Sick Total
____________________________________

DAYS DAYS DAYS

JB B. MANALANG _________________
OIC/ HRMO – I Principal - II

7c. APPROVED FOR: 7d. DISAPPROVED DUE TO:

_____________ Days with pay _____________________

_____________ Days without pay _____________________
_____________ Others (Specify) _____________________

________________________________
LEONARDO D. ZAPANTA, Ed. D.
Schools Division Superintendent
Officer In-Charge