APPLICATION FOR LEAVE

CSC FORMS 6 Employee No. 4181897

Revised 1984

1. OFFICE/ AGENCY 2. NAME (Last) (First) (Middle)

DEPED RULL JOAN APAN

3. Date of Filing 4. Position 5. Salary (Monthly)
JANAUARY 22, 2020 TEACHER I 21,610.00
DETAILS OF APPLICATION
6. a. )TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT
/ / Vacation (1) IN CASE OF VACATION
_______ To seek employment / / within
the Philippines
------------- Others
(Specify) / / Abroad
(Specify) _______________________
/ / Sick (2) IN CASE OF SICK LEAVE
/ / Maternity / / In hospital (Specify) ____________________
/ X / Others
(Specify) SEMINAR FOR HOUSE AGENT / / Outpatient (Specify____________________
c) NUMBER OF WORKING DAYS APPLIED FOR d) COMMUTATION

2 ( TWO) ____ /X/ Requested / / Not Requested

INCLUSIVE DATES: JANUARY 23-24,2020

__________________________________
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. a.)CERTIFICATION OF LEAVE CREDITS b) RECOMMENDATION
AS OF _____________________ / / Approved / / Disapproved due to ____
_________________________
____________________________________
Vacation Sick Total

____________________________________

ARIEL M. CABANTOG REYNANTE M. SOFERA

__________________________ PSDS – District V
Administrative/ Personnel Officer

c) RECOMMENDATION
/ / Approval / / Disapproved

EDNA FAURA-AGUSTIN
Schools Division Superintendent
d) APPROVED FOR e) DISAPPROVED DUE TO
____________days with pay _____________________________
____________ days without pay _____________________________
____________ others (Specify) _____________________________

__________________________________
Signature

_________________________________
(Authorized)

NOTE:
1. Application for vacation leave or sick leave for one full day or more shall be made on this form to be accomplished at least in duplicate.
2. Application for vacation leave shall be filed in advance or whenever possible fir (5) days before going on such leave.
3. Application for sick leave filed in advance or exceeding five days shall be accomplished by a medical certificate. In case of medical
certificate was not availed or an affidavit should be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his
unauthorized leave of absence.
5. An application for leave of absence of thirty (30) calendar days or more shall be accomplished by a clearance from money and property
accountability.