CS FORM 6

APPLICATION FOR LEAVE

______________________________________________________________________________________________________
1. OFFICIAL AGENCY: DepEd 2. NAME (Last) (First) (Middle)
District: Lutayan II _______________________________________________________
________________________________________________________________________________________________________
3. Date of Filing 4. Position 5. Salary (Monthly)
________________________________________________________________________________________________________
DETAILS OF APPLICATION
________________________________________________________________________________________________________
6(a) TYPE OF LEAVE 6(b) WHERE LEAVE WILL BE USED/SPENT
IN CASE OF VACATION LEAVE

( ) vacation ( ) Within the Philippines

( ) To seek employment ( ) Abroad
( ) maternity IN CASE OF SICK LEAVE
( ) Sick ( ) In Hospital
( ) Others ( ) Out patient (Specify) _________
________________________________________________________________________________________________________
6(c) NUMBER OF DAYS APPLIED FOR ___________ 6(d) COMMUTATION
Inclusive Dates:
From: ______________ to ______________ ( ) Requested ( ) Not requested

__________________________________
(Signature of Applicant)

Employee No. ________________

C.S. Status ___________________
Date of Orig. Appt. _____________

7(a) CERTIFICATION OF LEAVE CREDITS 7(b) RECOMMENDATION

TOTAL EARNED LEAVE VL SL
As of ______________ _____ _____ ( ) Approved
( ) Not approved due to
______________________
TOTAL LEAVE ENJOYED:
Balance as of _____ ______ __________________________________
Less this application _____ ______
Balance as of _____ ______

ADORA S. VILLA AKMAD M. MANTOG

Administrative Officer IV District Supervisor
_______________________________________________________________________________________________________
7(c) APPROVED FOR 7(d) DISAPPROVED DUE TO:

_______________ Days with pay _________________________

_______________ Days without pay _________________________
_______________ Others (specify) _________________________
APPROVED:

LEONARDO M. BALALA, PhD., CESE

Schools Division Superintendent
Date: ______________________________
INSTRUCTIONS:
1. Application for vacation leave or sick leave for one full day or more shall made on this form to be accomplished at
least in duplicate.
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going to such
leave.
3. Application for sick leave filed in advance or exceeding five days shall be accompanied by a medical certificate.
In case medical consultation was not availed of, an affidavit should be executed by the applicant.
4. An employee who is absent without leave shall not be entitled to receive his/her salary corresponding to the period
of his unauthorized leave of absences.
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by clearance from
money and property responsibility.