CSC Form 6

APPLICATION FOR LEAVE

_________________________________________________________________________
1. OFFICE/AGENCY: Department of Education 2. NAME (last) (first) (middle)
2. DIVISION OR CITY SCHOOL: Loreto East District PEREZ, XYLA JOY, ARANETA
San Isidro National High School

______________________________________________________________
3. DATE OF FILLING 4. POSITION 5. SALARY (monthly)

NOVEMBER 20, 2019 TEACHER I 20,754.00

_________________________________________________________________________
DETAILS FOR APPLICATION

6. TYPE OF LEAVE 6.B. WHERE LEAVE WILL BE SPENT

(1) IN CASE OF VACATION LEAVE:
Vacation Within the Philippines
To seek employment Abroad ________________
Others (specify) PERSONAL ____________________
______________ (2) IN CASE OF SICK LEAVE:
Sick In Hospital (specify)______
Maternity ____________________
Others (specify) Out Patient (specify) _____
______________________ ______________________

C. NUMBER OF WORKING DAYS APPLIED FOR: D. COMMUTATION:

__1 day________ Requested Not Requested

INCLUSIVE DATE/S __NOVEMBER 22, 2019_

__________________
Signature of Applicant
_________________________________________________________________________
DETAILS OF ACTION ON APPLICATION

7.A. CERTIFICATE OF LEAVE OF CREDITS 7.B. RECOMMENDATION

As of _____________________ Approval
_____________________________ Disapproval due to ____________
____________________________

VACATION : SICK : TOTAL

__________________________________
__________________________________
__________________________________
DAYS : DAYS : DAYS
LOURDES G. MIRA
Coordinating Principal
___________________________
Personnel Officer
_________________________________________________________________________
7.C. APPROVED FOR: 7.D. RECOMMENDATION

________ days with pay Approval

________ days without pay Disapproval due to ____________
________ others (specify) ___________________________

DR. LORENZO O. MACASOCOL, CESE

OIC-School Division Superintendent

Date: _________________
1. Application for Vacation/Sick Leave for one day or more shall be made on this form and to be accomplished at
least in duplicate
2. Application for Vacation Leave shall be filed in advance or whenever possible 5 days before going to such leave
3. Application for Sick Leave filed in advance or exceeding five (5) days shall be accompanied with Medical
Certificate. In case Medical Certificate is not valid of, an affidavit of absence shall be executed.