CSC Form 6
Revised 1994
APPLICATION FOR LEAVE
(9 DAYS BELOW)
__________________________________________________________________________________________________
1.OFFICE/AGENCY 2. NAME (Last) (First) (Middle)
DepEd Calapan ABELGAS NONA SHELLA DIAZ
3. Date of Filing 4. Position 5. Salary (Month)
September 30, 2020 TEACHER II ₱ 24,495.00
DETAILS OF APPLICATION
6. a ) TYPE OF LEAVE 6. b ) WHERE LEAVE WILL BE SPENT
/ /Vacation ( 1 ) IN CASE OF VACATION
_________To seek employment / / within the Philippines
_________ Others ( Specify ) / / Abroad (Specify)_______________________
/ √ / Sick ( 2 ) IN CASE OF SICK LEAVE
/ /Maternity / / In hospital ( Specify )____________________
/ / Others (Specify___________________ / / Outpatient ( Specify )____________________
6. c ) NUMBER OF WORKING DAY/S 6. d ) COMMUTATION
APPLIED FOR_ 1 day_ ________________ _____Requested ____Not Requested
INCLUSIVE DATES September 29, 2020
__________________________________________
Signature of Applicant
Employee No .__4742326___________
DETAILS OF ACTION ON APPLICATION
7. a ) CERTIFICATION OF LEAVE CREDITS ___________________________________________
AS OF ____________________________ 7. b ) RECOMMENDATIONS
________ Approval
_________________________________________ ________Disapproval due to____________________
Vacation Sick Total ___________________________________
_______ _________ ___________
_________________________________ LORRAINE F. SANGALANG
Administrative Officer V Principal II
7. c ) APPROVED FOR 7. d ) DISAPPROVED DUE TO
____________________ days with pay _______________________________
____________________ days without pay _______________________________
____________________ others (Specify )
Date:______________________
___LYNN G. MENDOZA___
OIC-Office of the Assistant Schools Division Superintendent
Note:
1. Applicant for vacation leave or sick leave for one full day or more be made on this form to be accomplish at least in duplicate
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 five days shall be accompanied by medical certificate. In case of medical certificate was
not availed or an affidavit should be by the applicant
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his unauthorized
leave of Absence.
5. An application for leave of absence of thirty (30) calendar days or more shall be accompanied by accompanied by clearance from money and
property accountability.
CSC Form 6
Revised 1994
APPLICATION FOR LEAVE
(9 DAYS BELOW)
__________________________________________________________________________________________________
1.OFFICE/AGENCY 2. NAME (Last) (First) (Middle)
3. Date of Filing 4. Position 5. Salary (Month)
DETAILS OF APPLICATION
6. a ) TYPE OF LEAVE 6. b ) WHERE LEAVE WILL BE SPENT
/ /Vacation ( 1 ) IN CASE OF VACATION
_________To seek employment / / within the Philippines
_________ Others ( Specify ) / / Abroad (Specify)_______________________
/ / Sick ( 2 ) IN CASE OF SICK LEAVE
/ /Maternity / / In hospital ( Specify )____________________
/ / Others (Specify) ___________________ / / Outpatient ( Specify )____________________
6. c ) NUMBER OF WORKING DAY/S 6. d ) COMMUTATION
APPLIED FOR__ _____________ _____Requested ____Not Requested
INCLUSIVE DATES:__ ___
__________________________________________
Signature of Applicant
Employee No .________________________
DETAILS OF ACTION ON APPLICATION
7. a ) CERTIFICATION OF LEAVE CREDITS ___________________________________________
AS OF ____________________________ 7. b ) RECOMMENDATIONS
________ Approval
_________________________________________ ________Disapproval due to____________________
Vacation Sick Total ___________________________________
_______ _________ ___________
___________________________________ LORRAINE F. SANGALANG
Administrative Officer V Principal II
7. c ) APPROVED FOR 7. d ) DISAPPROVED DUE TO
____________________ days with pay _______________________________
____________________ days without pay _______________________________
____________________ others (Specify )
Date:______________________
___LYNN G. MENDOZA___
OIC-Office of the Assistant Schools Division Superintendent
Note:
1. Applicant for vacation leave or sick leave for one full day or more be made on this form to be accomplish at least in duplicate
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 five days shall be accompanied by medical certificate. In case of medical certificate was
not availed or an affidavit should be by the applicant
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his unauthorized
leave of Absence.
5. An application for leave of absence of thirty (30) calendar days or more shall be accompanied by accompanied by clearance from money and
property accountability.
