CSC Form 6 Republic of the Philippines

(Revised 2015) DEPARTMENT OF EDUCATION

Regional Office No. VIII (Eastern Visayas)
DIVISION OF NORTHERN SAMAR
Catarman, Northern Samar

APPLICATION FOR LEAVE

1. Office/Agency Employee ID/Number: 0010819

DepED Northern Samar School/Office: (detailed at Galutan National High School)
Cawayan National High School District: Catarman IV
(detailed at Galutan National High School) Employee Contact Number: 09093837760

2. Name: GORDA, RAYMOND ARNIÑO

(Last Name) (First Name) (Middle Name)

3. Date of Filing: 4. Position: Secondary School Teacher III

May 2, 2016 5. Monthly Salary: Php 22,328.00

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
ü Others (Please specify)
Study Leave

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

Inclusive dates: April 4, 2016 - March 31, 2017 RAYMOND A. GORDA

(Signature over Printed Name of Employee)

TERESITA C. MARINO
(Signature over Printed Name of Immediate Head)

DETAILS OF ACTION ON APPLICATION

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

Administrative Officer Administrative Officer

7. C. APPROVED FOR: 7. D. DISAPPROVED due to:

days with pay

days without pay

MANUEL P. ALBAÑO, 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.