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Application For Leave: Deped-Dagupan City Employee No. Name School: Caranglaan Es Last First Middle

This document is an application for leave form from the DepEd-Dagupan City school district. It contains sections for the applicant to provide their name, position, type of leave being requested (e.g. vacation, sick), number of working days for the leave, dates of the leave, certification of leave credits, and recommendations and approvals from supervisors. The form notes requirements such as applications for vacation leave must be submitted 5 days in advance when possible, and sick leave exceeding 5 days requires a medical certificate.

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Belle Quitua Balolong
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104 views1 page

Application For Leave: Deped-Dagupan City Employee No. Name School: Caranglaan Es Last First Middle

This document is an application for leave form from the DepEd-Dagupan City school district. It contains sections for the applicant to provide their name, position, type of leave being requested (e.g. vacation, sick), number of working days for the leave, dates of the leave, certification of leave credits, and recommendations and approvals from supervisors. The form notes requirements such as applications for vacation leave must be submitted 5 days in advance when possible, and sick leave exceeding 5 days requires a medical certificate.

Uploaded by

Belle Quitua Balolong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

APPLICATION FOR LEAVE

CSC Form No. 6


9

DEPED-DAGUPAN CITY Employee NAME


No.
School: LAST FIRST MIDDLE

CARANGLAAN ES
Date of Filing: Position Title: Monthly Salary:
Php
A.) TYPE OF LEAVE B). WHERE WILL BE SPEND
IN CASE OF VACATION LEAVE:
______ Vacation ( ) Within the Philippines
______ To seek employment ( ) Abroad (Specify)
______ Others (Specify)
___________________________
___________________________ IN CASE OF SICK LEAVE:
___________________________ ( ) In Hospital (Specify)___________________
___/___ Sick ( ) Out Patient (Specify) __________________
______ Maternity
______ Others (Specify)
___________________________

C.) NO. OF WORKING DAYS APPLIED FOR: __ day D.) Commutation


Inclusive Date(s): ( ) requested
( ) not requested

________________
Signature of Applicant

A. CERTIFICATION OF LEAVE CREDITS B.)RECOMMENDATION


As of _______________________ ( ) Approval
( ) Disapproved due to:
________________________________

Vacation Sick Total


JOHN SILVESTER A. ALIPIO,
Ph.D.
OIC-Principal

RECOMMENDING APPROVAL:

MYREL ANGELICA N. LOPEZ


Administrative Officer V

A.) APPROVED FOR: B. DISAPPROVED DUE TO:

_____________ Days with pay _____________________


_____________ Days without pay _____________________
_____________ Others (Specify) _____________________

APPROVED:
LORNA G. BUGAYONG, Ph. D., CESO VI
Schools Division Superintendent
1. Application for one (1) full day leave shall be made on this form.
2. Application for vacation leave shall be filled in advance or whenever possible five (5) days before going on such leave.
3. Application for sick leave, filled in advance, or exceeding in five (5) days shall be accompanied with a medical certificate. In case medical consultation was
not availed then an affidavit should be executed by the applicant.
4. An employee who is absent without an approved leave shall not receive his/her salary corresponding to the period of unauthorized leave of absence.
5. An application for thirty (30) calendar days or more of leave of absence shall be accompanied with a clearance from financial and property accountabilities.

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