APPLICATION FOR LEAVE
CSC FORM 6
1. OFFICE / AGENCY
SAN VICENTE ELEMENTARY SCHOOL /
STA MARIA EAST DISTRICT
3. Date of Filing:
DETAILS OF APPLICATION
5. a) TYPE OF LEAVE
_______ Vacation
_______ To seek employment
Others (Specify) _________
______________________
_______ Sick
_______ Maternity
_______ Others
b) NUMBER OF WORKING DAYS
APPLIED FOR: _____________
INCLUSIVE DAYS: _____________
______________________________
______________________________
DETAILS OF APPLICATION
7. (a) CERTIFICATION OF LEAVE CREDITS
As of _________________________
Vacation Sick Total
JOSEFINA S. PEDROCHE
Administrative Officer IV
7. c) APPROVED FOR :
_________ Days with pay
_________ Days without pay
_________ Others (Specify)
CECILIA E. VALDERAMA, Ph.D.
Assistant Schools Division Superintendent
2. NAME (LAST) (FIRST) (MI)
4. Position: Salary:
6. WHERE LEAVE WILL BE SPENT
a) IN CASE OF VACATION LEAVE
_________Within the Philippines
_________ Abroad (Specify) _______
_____________________
b) IN CASE IF SICK LEAVE
_______ In Hospital (Specify)______
_______________________
_______ Out-patient (Specify) _____
_______________________
COMMUTATION:
_____ requested _____not requested
_______________________ ___________
Signature of Applicant Emp. No.
7. (b) RECOMMENDATION
_______ APPROVAL
_______ DISAPPROVAL due to _____
_________________________
_________________________
MONALIZA M. VILLANUEVA
Principal III / Department Head
LEONORA V. BERGADO, EdD
Public Schools District Supervisor
7. (d) DISAPPROVED
Authorized Official