CSC FORM 6

APPLICATION FOR LEAVE

1.Office/Agency Name (Last) (First) (Middle)

(School Assignment)

2. Date of Filing Position Salary

DETAILS OF APPLICATION

3. a) Type of Leave 4. b) Where Leave will be spent:

____ Vacation (1) In case of Vacation Leave
____ To seek employment ____ Within the Philippines
____ Others (Specify) ____ Abroad (Specify)
______________________________ _________________________________________
____ Sick (2) In case of Sick Leave
____ Maternity In Hospital (Specify) _________
____ Others (Specify) _____________ Out Patient (Specify) _________

5. c) Number of Working Days Commutation

Applied for _______________ ____ Requested
Inclusive Dates _________________ ____ Not Requested
__________________

___________________________________
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

6. a) Certification of Leave Credits 7. b) Recommendation:

as of:
______________________________________________
Approval
Vacation Sick Total Disapproval due to _____________________
_____________________________________________

___________________________________
MARIA NICHOLETTE C. ROJO Authorized Official
Administrative Officer IV

8. c) APPROVED FOR: 9. d) DISAPPROVED DUE TO

_________ day/s with pay ______________________________________
_________ day/s without pay
_________ Others (specify) ________________

APPROVED:

MAYLENE M. MINIMO, Ed. D., CESE

OIC – Assistant Schools Division Superintendent