CSC Form 6

Revised 1998

APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First) (Middle)

3. Date of Filing 4. Position 5. Salary

DETAILS OF APPLICATION
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)

6. C) Number of Working Days applied for: 6. D) Commutation

Requeste Not Requested
Inclusive Dates

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of

Vacation Sick Total Approval

Disapproval due to
days days days

JB B. Manalang Leonardo D. Zapanta Ed.D., CESO VI

Administrative Officer-IV OIC - School Division Supt.
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

Nicolas T. Capulong Ph.D., CESO VI

Asst. Regional Director , OIC
Date: _________________
Requested
CSC Form 6
Revised 1998

APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First) (Middle)
DepEd Minalin
3. Date of Filing 4. Position 5. Salary

DETAILS OF APPLICATION
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)

6. C) Number of Working Days applied for: 6. D) Commutation

Requeste Not Requested
Inclusive Dates

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of

Vacation Sick Total Approval

Disapproval due to
days days days

JB B. Manalang ________________________
Administrative Officer-IV School Head
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

Leonardo D. Zapanta Ed.D.,CESO VI

OIC - School Division Superintendent

Date: _________________
Requested
CSC Form 6
Revised 1998

APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First) (Middle)
DepEd Minalin MUTUC CHRIZ LENNIN SALITA
3. Date of Filing 4. Position 5. Salary
0CTOBER 16, 2019 TEACHER I ###
DETAILS OF APPLICATION
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)

6. C) Number of Working Days applied for: 6. D) Commutation

Requeste Not Requested
Inclusive Dates

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of

Vacation Sick Total Approval

Disapproval due to
days days days

JB B. Manalang
Administrative Officer-IV School Head
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

Leonardo C. Canlas Ed.D., CESE

OIC - Asst School Division Supt

Date: _________________