REPUBLIC OF THE PHILIPPINES

CEBU CITY
OFFICE OF THE MAYOR
LOCAL SCHOOL BOARD
9/F Executive Building Cebu City Hall, M.C Briones St.

LSB-Admin Form #: 0001

APPLICATION FOR LEAVE

OCSC FORM NO. 6
REVISED 1985
1. OFFICE/AGENCY 2. NAME (Last)(First)(Middle)(ext.) STATUS

LOCAL SCHOOL BOARD CASUAL

3. DATE OF FILLING 4. POSITION 5. SALARY MONTHLY

6. a.) TYPE OF LEAVE 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) Out Patient (Specify)

6. c.) NUMBER OF WORKING 6 d.) COMMUTATION

DAYS .

DAYS APPLIED FOR: Requested Not Requested

INCLUSIVES DATES:
(Signature of Applicant)
7. a.) CERTIFICATION OF 7. b.) RECOMMENDATION
LEAVE CREDITS

LEAVE CREDITS AS OF: _______ Approval

Disapproval due to
VACATION SICK LEAVE

OLANI MARIE N. BONGATO

RICHEL L. DIONSON __________________ EXECUTIVE ASSISTANT III
(Leave In-charge) (Unit/Section Head) (Immediate Supervisor)

7. c.) APPROVED FOR 7. d) DISAPPROVED DUE TO

DAYS WITH PAY

DAYS WITHOUT PAY
OTHERS (SPECIFY) POSTER:

By Authority of the Mayor:

MARIA LUISA A. AMAYA

HRMO III
ACTING CHIEF, LEAVE SECTION