Document Code: SDO-QF-SDOP-PER-17

Quality Form Revision: 00

Effectivity date: 05-25-2018

Name of Office:
APPLICATION FOR LEAVE SDOP-PER

CSC FORM 6
1.OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)
STA. JULIANA HIGH SCHOOL
(OHS-ANNEX)

2. Date of Filing: February 3, 2020 3. Position: Teacher II Salary: 22 938

DETAILS OF APPLICATION
5.a) TYPE OF LEAVE 6. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify)

b) IN CASE IF SICK LEAVE

_______ In Hospital (Specify
_______ Sick/ WITH FEVER _______ Out-patient (Specify)
_______ Maternity
_______ Family Matters ____________________________

b) NUMBER OF WORKING DAYS COMMUTATION:

APPLIED FOR:
_____ requested _____not requested
INCLUSIVE DAYS: February 6, 2020
_______________________
Signature of Applicant Emp. No. 5386839

DETAILS OF APPLICATION
7. (a) CERTIFICATION OF LEAVE CREDITS 7. (b) RECOMMENDATION
As of _________________________
_______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________

JOVITA G. DIZON LIEZL M. SANCHEZ

Administrative Officer V SCHOOL HEAD
a7. c) APPROVED FOR : 7. (d) DISAPPROVED

_________ Days with pay

_________ Days without pay
_________ Others (Specify)
RONALDO A. POZON, Ph. D. CESO V
Officer-In-Charge
Schools Division Superintendent
Authorized Official

QM - Page 1 of 1