DepEd Form 6

APPLICATION FOR LEAVE

1. OFFICE/AGENCY 2. NAME
DIVISIONOF CAGAYAN DE ORO CITY Last First M.I.
WEST I DISTRICT

MACANHAN ELEMENTARY SCHOOL

(School)
3. Date of Filing 4. Position 5. Salary (Monthly)

DETAILS OF APPLICATION\
6. (a) NATURE OF LEAVE 6. (b) Where leave will be spent
_____________ Vacation
_____________ To seek employment (1) In case of vacation leave
_____________ Others (specify) ____________ within the Philippines
____________ abroad (specify)

(2) In case of sick leave

_____________ Sick ____________ in the hospital (specify)
_____________ Maternity
_____________ Others

6. (c) Number of days applied for Outpatient (specify)

Inclusive dates ________________________ _______ requested ________ not requested

________________________
________________________
Signature of Applicant

DETAILS OF ACTION OF APPLICATION

7. (a) Certification of Leave Credits 7. Recommendations
Vacation Sick Total
_____________ approved

Days Days days _____________ disapproved due to ___________

EDNA L. MAGHINAY MARJORIE S. OBSIOMA

Administrative Officer V School Principal II

7. (c) Approved for: 7. (d) Disapproved due to:

_______________ days with pay
_______________ days without pay
_______________ others
__________________________________________
__________________________________________
__________________________________________

CHERRY MAE L. LIMBACO

Schools Division Superintendent