CS Form 6

Republic of the Philippines

Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300

APPLICATION FOR LEAVE

1. OFFICE/AGENCY 2. NAME (Last) (First) (M.I.)
DEPED - DARAGUTAN EAST NHS ACOB WENDELIN E.
3. Date of Filing 4. Position 5. Montly Salary
January 13, 2020 Principal I P 45,269.00
6a. TYPE OF LEAVE 6b. WHERE LEAVE BE SPENT

Vacation a. In case of vacation leave

To seek employment Within the Philippines

Sick Abroad (Specify) __________________

Maternity b. In case sick leave

X Others (Specify) : In Hospital (Specify)

Attend to urgent personal concern

6c. Number of Working Days Applied 6d. COMMUTATION

X Requested Not Requested

For ONE (1) day
Inclusive date(s) January 13, 2020

_______________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7A. Certification of Leave Credits 7b. RECOMMENDATION

As DSO No. ________ _________ days Approval

________ _________ days
Vacation Leave ______ _________ days Disapproved due to
Sick Leave ________ _________ days
________________________________
_________ days used ________________________________
_________ Balance ________________________________

LOU JANE M. NICOLAS ROBERT M. GELACIO

Human Resource Management Officer I Principal In-charge
7c. APPROVED FOR: 7D. DISAPPROVED DUE TO:
___________ Days with pay
___________ Days without pay
___________ Others ( Specify)
_______________

MADELYN L. MACALLING PhD CESO VI

OIC, Schools Division Superintendent