Republic of the Philippines

Department of Education
Region VI - Western Visayas
SCHOOLS DIVISION OF ILOILO
Luna St., La Paz, Iloilo City

CSC Form 6
Revised 1984
APPLICATION FOR LEAVE
1. DISTRICT/SCHOOL/OFFICE 2. LAST NAME FIRST NAME MIDDLE NAME

3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT
Vacation b.1. In case of Vacation Leave
To seek employment Within the Philippines
Others (specify) Abroad (specify)

Sick b.2. In case of Sick Leave

Maternity / Paternity In Hospital (specify)
Others (specify) Out Patient
--
6. c) NUMBER OF WORKING DAYS APPLIED FOR -- 6. d) COMMUTATION
APPLIED FOR Requested
INCLUSIVE DATES Not requested

Signature of Applicant
Employee Number
Date of Original Appointment

DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
as of Approval
Disapproval
Vacation Sick CTO/COC PL Others TOTAL
EARNED
SPENT
BALANCE BONIFACIO D. CAMILON
Officer-In-Charge

MIKEE GRACE N. MONTECLARO

Administrative Officer IV

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

day/s WITH pay
day/s WITHOUT pay
others (specify)

___________________________________________________
NORDY D. SIASON JR., Ed. D.
Asst. Schools Division Superintendent
DATE: ____________

DepEd SCHOOLS DIVISION OF ILOILO, Luna St., La Paz, Iloilo City 5000 | Tel./Fax No. (033) 320-1402 | ICT-Unit Direct Line: (033) 320-0710
Trunk Lines: (033) 320-0707| 320-0728 | 320-0719 | Website: http://www.depediloilo.ph | e-mail: iloilo@deped.gov.ph