CSC Form No.

6
Revised 1984

APPLICATION FOR LEAVE

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

DepEd- Danao City LAUREL KIMBERLY PEREZ
3. DATE OF FILING 4. POSITION / LEVEL 5. SALARY (MONTHLY)
November 4, 2019 TEACHER I ₱ 21,038.00
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
Other (Please Specify) ✔ Out Patient (Please Specify)

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

APPLIED FOR 1 Day ✔ Requested
OCTOBER 31,2019 Not Requested

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

ALAN M. LAURO
School Head

MA. MONINA L. PATOLTOL

HRMO

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

LEAH P. NOVERAS, Ed. D. CESO VI

Schools Division Superintendent