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Application For Leave

This document is an application for leave form from the Department of Education Region VIII Division of Samar. It contains the applicant's information including name, position, monthly salary, type of leave being applied for, number of working days, and inclusive dates. It must be verified by the applicant's chief/section head and contains details of the action taken on the application including certification of leave credits and the recommendation for approval or disapproval. If approved, it specifies the number of days approved with or without pay. It is signed by the Schools Division Superintendent. Notes at the bottom provide instructions that application for vacation or sick leave over one day must be made using this form, that vacation leave requires advance filing, and that unauthorized absence without approved

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Jinn Dalisay Uy
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2K views2 pages

Application For Leave

This document is an application for leave form from the Department of Education Region VIII Division of Samar. It contains the applicant's information including name, position, monthly salary, type of leave being applied for, number of working days, and inclusive dates. It must be verified by the applicant's chief/section head and contains details of the action taken on the application including certification of leave credits and the recommendation for approval or disapproval. If approved, it specifies the number of days approved with or without pay. It is signed by the Schools Division Superintendent. Notes at the bottom provide instructions that application for vacation or sick leave over one day must be made using this form, that vacation leave requires advance filing, and that unauthorized absence without approved

Uploaded by

Jinn Dalisay Uy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Application for Leave

DEPARTMENT OF EDUCATION

Region VIII
DIVISION OF SAMAR
Catbalogan City
_____________________________________________________________________________
APPLICATION FOR LEAVE
CSC Form 6
(Revised 1998)
1. Office / Agency Employee/ID number:______________________________
DepED – Division of Samar School / Office: ______________________________
District: ______________________________
Employee Contact Number:_________________________

2. Name_____________________________________________________________________________________
(Last Name) (First Name) (Middle Name)

3. Date of Filing: 4. Position: _________________________________


__________________________ 5. Monthly Salary: _________________________________
DETAILS OF APPLICATION
6. a. Type of Leave 6. b. Where leave will be spent in case of Vacation Leave?
__________Vacation Leave _____________________________________________
__________To seek employment _____________________________________________
__________Forced Leave _____________________________________________
__________Sick Leave In case of Sick Leave, please specify the place of recovery.
__________Maternity Leave _____________________________________________
__________Others (Please spicify) _____________________________________________
__________________________________ _____________________________________________
__________________________________
Commutation_________Requested
7. Number of working days applied: _______ _________Not Requested
Inclusive dates: ________________________
________________________ ___________________________________________
(Signature over Printed Name of Employee)
Verified and validated by:
_______________________________________________
(Signature Over Printed Name of Chief/Section/Immediate Head)
__________________________________________________________________________________________
DETAILS OF ACTION ON APPLICATION
7. A. Certification of Leave Credits as of__________,20___ 7. B. Recommendation
Total leave credits
Vacation leave credits Sick leave credits
balance
Approved
Less: Less:
Disapproved

LEAH ERAYA WIGBERTO BELIZAR, JR.


Administrative Officer IV Administrative Officer V
___________________________________________________________________________________
7. APPROVED FOR: 7. D. DISAPPROVED due to:

__________days with pay _____________________________


__________days without pay _____________________________

MARIZA S. MAGAN, Ed. D., CESO V.


Schools Division Superintendent
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four
copies
2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accomplished
with medical certificate.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period
his authorized leave of absent.

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