CSC Form No.

6
Received 1984
APPLICATION FOR LEAVE
1. OFFICIAL/AGENCY 2. NAME (Last) (First) (Middle)

DEPED, SDN BECERRO LEA MADELON GALAURA

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

June 30, 2020 Administrative Asst. II 17,505.00

DETAILS OF APPLICATION
6. a.) TYPE OF LEAVE 6.b.) WHERE LEAVE WILL BE SPENT:
(1.) IN CASE OF VACATION LEAVE
( ) Vacation ( ) Within the Philippines
( ) To seek employment ( ) Abroad (Specify) ____________________
( ) Others (Specify) __________________________ ____________________________________
___________________________________________
( ) Sick (2.) IN CASE OF SICK LEAVE
( ) Maternity ( ) In Hospital (Specify) __________________
( / ) Others (Specify) ____________________________________
( ) Out Patient (Specify) __________________
Special Leave_________ ____________________________________
6.c.) NUMBER OF WORKING DAYS APPLIED FOR 6.d.) COMMUTATION
( / ) Requested ( ) Not Requested
2 days
__________________
(Signature of Applicant)
INCLUSIVE DATES: July 1-2,2020
DETAILS OF APPLICATION
7.a.) CERTIFICATION OF LEAVE CREDITS 7.b.) RECOMMENDATION

As of ____________________________ ( ) Approval

Vacation Sick Total ( ) Disapproval due to______________

_____________________________

JULIET DUMAGUIT-GO
Accountant III
RACHEL JADE DELA CRUZ ( Authorized Official)
Administrative Officer IV - HRMO

7.c.) APPROVAL FOR: 7.d.) DISAPPROVAL DUE TO:

_____ _______ DAY WITH PAY __________________________________

_______________ DAYS WITHOUT PAY __________________________________
_______________ OTHERS
________________________________
(Signature)

LAILA F. DANAQUE
OIC-Schools Division Superintendent