Document Code: SDO-BTN-QF-OSDS-PER-006

Revision: 01
QUALITY FORM
Effectivity date: 06-20-2019

Name of Office:
Form 6
SDO – HERMOSA ANNEX

APPLICATION FOR LEAVE

1. School/District 2. Name (Last) (First) (Middle)

SDO – HERMOSA ANNEX SALAC ENRIQUE CASUPANAN

3. Date of Filing 4. Position 5. Salary

11 – 12 – 2019 Teacher I - ALS 21,327.00
DETAILS OF APPLICATION
6. (a) Type of Filing 6. (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) FORCE LEAVE
F Out Patient (Specify)
6. (c) Number of working days applied for: 1 DAY/S
6. (d) Commutation
Inclusive Dates:
Requested
From To Not Requested
mm dd yyyy mm dd yyyy
11 14 2019 11 14 2019

ENRIQUE C. SALAC
Name and Signature of Applicant
7. (a) Certification of Leave Credits 7. (b) Recommendation
as of: Approval
Vacation Sick Total Disapproval due to

RONIE S. MENDOZA
Roshenar V. Cruz Unit Head / Principal / PSDS
Administrative Officer IV Authorized Official
7. (c) Approved for: 7. (d) Disapproved due to
days with pay
days without pay
others (specify)
APPROVED:

ROMEO M. ALIP, Ph.D., CESO V

Schools Division Superintendent

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