Form 6

Revised 1984

APPLICATION FOR LEAVE

1. Office / Agency 2. Name (Last) (First) (Middle )

3. Date of filing 4. Position 5. Salary (Monthly)

DETAILS OF APPLICATION
6. a) Type of Leave 6. b) where will be leave 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) ______________
_______________ Out Patient (Specify) ___________
_______________________________

6. c) Number of Working / Days applied for ½ day d) Commutation

Inclusive Dates ____________________ Requested Not Requested

______________________________________
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. a.) Certification of Leave Credit as of 7.b) Recommendation

Vacation Sick Total Approval

Days Days Days
Disapproval due to ________________
____________________________________

JOEL A. ARCILLO
School Principal I

DR. ANTONIO N. OLFINDO

Public School District Supervisor

7. c.) Approved for: d.) Disapproved due to:

_________ Days with pay

_________ Days without pay _____________________________________
_________ Others (Specify) _____________________________________