CSC Form No.

6
Department of Science and Technology
PHILIPPINE SCIENCE HIGH SCHOOL
Cordillera Administrative Region Campus

APPLICATION FOR LEAVE

Instruction:
Vacation Leave - TO be filed 5 days in advance and obtain approval before going on leave; attach clearance if lelave is one (1) month or more
Sick Leave - To be filed upon return or in advance; attach medical certificate if leave is more than 5 days.
Maternity Leave - Attach clearance and medical certificate to application. Solo Parent Leave - Attach photocopy of valid solo parent ID Card
Paternity Leave - Attach photocopy of birth certificate of newborn child.

Compensatory Day-Off - Attach Special Order

1. OFFICE/ AGENCY 2. NAME (Last) (First) (Middle)
DOST, PSHS-CAR CAMPUS
3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT:
[ ] Vacation (1) IN CASE OF VACATION LEAVE
[ ] Sick Leave [ ] Within the Philippines
[ ] Special Leave Privilege [ ] Abroad (Specify) ___________________
[ ] Others (specify) ___________________ (2) IN CASE OF SICK LEAVE
[ ] Compensatory Day Off in lieu of: ____________ [ ] In Hospital (Specify) _________________
[ ] Terminal Leave [ ] Out Patient (Specify) ________________
6. c) NUMBER OF WORKING DAYS 6. d) COMMUTATION:
APPLIED FOR: [ ] Requested [/ ] Not Requested
INCLUSIVE DAYS:

(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS: 7. b) RECOMMENDATION
AS OF ______________________ [ ] Approval ________________________
[ ] Disapproval due to ________________
Vacation Sick CTO Total ________________________________
Total-to-date
Less: this leave
Grand Total MELBA C. PATACSIL
(Name and Signature of Authorized Official)

CISD/SSD Chief
Posted by: FRESCA S. NEDIC (Designation)
(HRMO)
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:
[ ] days with pay _______________________________
[ ] days without pay _______________________________

Dr. CONRADO C. ROTOR, JR.

Campus Director
Submit in 2 copies to HRMO
 lave is one (1) month or more

py of valid solo parent ID Card

(Middle)

RY (Monthly)

BE SPENT:

___________________

y) _________________
ify) ________________

ot Requested

of Applicant)

_________________
________________
_________________

BA C. PATACSIL
of Authorized Official)

SD/SSD Chief
nation)
____________
____________