APPLICATION FOR LEAVE

CSC Form No 6
Revised 1984

OFFICE/AGENCY

Name

(Last)

(Date of Filling)

(First)

POSITION

(Middle)
SALARY (MONTHLY)

DETAILS OF APPLICATION

a.) TYPE OF LEAVE

Vacation
To seek employment
Other (Specify) __________________
____________________________________

b.) Where Leave will be spent

Sick Leave
Maternity Leave
Other (Specify) ____________________
____________________________________
c.) Number of Working Days applied for:

In case of Sick Leave

In the Hospital (Specify) _____________
_________________________________
d.) Computation
Requested
Not Requested

Within the Philippines

Abroad (Specify) ___________________
_________________________________

Signature of Applicant

DETAILS OF APPLICATION
a.) Certification of Leave Credits

c.) Recommendation

As of ______________________________
____________________________________
Vacation

Days

Sick

Days

Approval
Disapproval due to _____________
Total

Days

____________________________________
Personal Officer
b.) Approved for:
__________ days with pay
__________ days without pay
__________other Specify

Noted by:
NATIVIDAD S. ALEJANDRO
Teacher-in-Charge

Approved:

By Authority of Schools
Division Superintendent
NYMPHIA GUEMO
Assistant Schools Division Superintendent

Authorized Official
d.) Disapproval due to ______________________
_________________________________________
_________________________________________