DEPARTMENT OF EDUCATION

Region VIII
DIVISION OF SAMAR
Catbalogan City

APPLICATION FOR LEAVE

(For 1-5 Days)
CSC Form 6
1. Office/Agency Employee ID/Number:
DepED - Division of Samar School/Office:
District:
Employee Contact Number:

2. Name:
(Last Name) (First Name) (Middle Name)

3. Date of Filing: 4. Position:

5. Monthly Salary:
DETAILS OF APPLICATION
6. a. Type of Leave 6.b. Where leave will be spent in case of Vacation Leave?
Vacation Leave
To seek employment
Forced Leave
Sick Leave In case of Sick Leave, please specify the place of recovery.
Maternity Leave
Others (Please specify)
Personal Leave

Commutation Requested
7. Number of working days applied: Not Requested
Inclusive dates:

(Signature over Printed Name of Employee)

Verified and validated by:

(Signature over Printed Name of Chief/Section/Immediate Head)

DETAILS OF ACTION ON APPLICATION

7. A. Certification of Leave Credits as of ___________, 20__
Vacation Sick Leave Total Leave
Leave Credits
Credits Credits Balance

Less: Less:

LEAH L. ERAYA
Administrative Officer IV
7. B. APPROVED FOR: 7. C. DISAPPROVED due to:

days with pay

days without pay

WIGBERTO C. BELIZAR, JR.

Administrative Officer V
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical certificate.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period his authorized leave of absence.
 DEPARTMENT OF EDUCATION
Region VIII
DIVISION OF SAMAR
Catbalogan City

APPLICATION FOR LEAVE

(For 6-59 Days)
CSC Form 6
1. Office/Agency Employee ID/Number:
DepED - Division of Samar School/Office:
District:
Employee Contact Number:

2. Nam
(Last Name) (First Name) (Middle Name)

3. Date of Filing: 4. Position:

5. Monthly Salary:
DETAILS OF APPLICATION
6. a. Type of Leave 6.b. Where leave will be spent in case of Vacation Leave?
Vacation Leave
To seek employment
Forced Leave
Sick Leave In case of Sick Leave, please specify the place of recovery.
Maternity Leave
Others (Please specify)

Commutation Requested
7. Number of working days applied: Not Requested
Inclusive dates:

(Signature over Printed Name of Employee)

Verified and validated by:

(Signature over Printed Name of Chief/Section/Immediate Head)

DETAILS OF ACTION ON APPLICATION

7. A. Certification of Leave Credits as of _________ 7. B. Recommendation
Vacation Leave Sick Leave Total Leave Credits
Credits Credits Balance
Approved
Less: Less:
Disapproved

LEAH ERAYA WIGBERTO C. BELIZAR, JR.

Administrative Officer IV Administrative Officer V
7. C. APPROVED FOR: 7. D. DISAPPROVED due to:
days with pay
days without pay

MARIO RODGIE R. SOMBILON, Ed.D

Assistant Schools Division Superintendent
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical certificate.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period his authorized leave of absence.
ed with medical certificate.
d leave of absence.
 DEPARTMENT OF EDUCATION
Region VIII
DIVISION OF SAMAR
Catbalogan City

APPLICATION FOR LEAVE

( For 60 Days Up)
CSC Form 6
1. Office/Agency Employee ID/Number:
DepED - Division of Samar School/Office:
District:
Employee Contact Number:

2. Name:
(Last Name) (First Name) (Middle Name)

3. Date of Filing: 4. Position:

5. Monthly Salary:
DETAILS OF APPLICATION
6. a. Type of Leave 6.b. Where leave will be spent in case of Vacation Leave?
Vacation Leave
To seek employment
Forced Leave
Sick Leave In case of Sick Leave, please specify the place of recovery.
Maternity Leave
Others (Please specify)

Commutation Requested
7. Number of working days applied: Not Requested
Inclusive dates:

(Signature over Printed Name of Employee)

Verified and validated by:

____________________________________
(Signature over Printed Name of Chief/Section/Immediate Head)

DETAILS OF ACTION ON APPLICATION

7. A. Certification of Leave Credits as of ___________ 7. B. Recommendation
Vacation Leave Sick Leave Total Leave Credits
Credits Credits Balance

Approved
Less: Less:
Disapproved
 LEAH ERAYA WIGBERTO C. BELIZAR, JR.
Administrative Officer IV Administrative Officer V
7. C. APPROVED FOR: 7. D. DISAPPROVED due to:
days with pay
days without pay

CARMELA R. TAMAYO, EdD, CESO V

Schools Division Superintendent
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical certificate.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period his authorized leave of absence.
h medical certificate.