APPLICATION FOR LEAVE

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

Deped-Cebu Province Arcelo MNHS (Liloan Dist.) BAYNO JONATHAN DUMAGPI

3. Date of Filing 4. Position 5. Salary

TEACHER 1 Php 242, 148.00
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

________________________ Requested 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
days days days Disapproval due to
______________________________

_______________________________ FLORIZA Q. PITOGO

Authorized Official Authorized Official
7. C) Approved for: 7. D) Disapproved due to:
__________ days with pay ________________________
__________ days without pay ________________________
____________________________________
Signature
____________________________________
Authorized Official

Date: __________________