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Out Patient (Specify)

This document is an application for leave form from the Department of Education Region X Division of Cagayan de Oro City. It collects information such as the applicant's name, position, type of leave being requested, number of working days for leave, inclusive dates of leave, and certification of leave credits. The form requires recommendations from the school principal and approval from an authorized official.

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Toga MarMar
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45 views1 page

Out Patient (Specify)

This document is an application for leave form from the Department of Education Region X Division of Cagayan de Oro City. It collects information such as the applicant's name, position, type of leave being requested, number of working days for leave, inclusive dates of leave, and certification of leave credits. The form requires recommendations from the school principal and approval from an authorized official.

Uploaded by

Toga MarMar
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
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CSC Form No.

Department of Education
Region X
DIVISION OF CAGAYAN DE ORO CITY
Cagayan de Oro City

APPLICATION FOR LEAVE

1 OFFICE/AGENCY 2 NAME: (LAST) (FIRST) (M.I.)


Dep ED Division of Cagayan de Oro City
First Legislative
Taglimao National High School-Tumpagon Annex
3 DATE OF FILING 4 POSITION 5 MONTHLY SALARY

6 A.) TYPE OF LEAVE 6 B.) WHERE LEAVE BE SPENT


______ Vacation
______ To seek employment 1) IN CASE OF VACATION LEAVE
______ Sick leave ______ Within the Philippines
______ Maternity ______ Abroad (Specify)
______ Others (Specify) ___________
________________________
2) IN CASE OF SICK LEAVE
6 C.) NUMBER OF WORKING DAYS APPLIED ______ in Hospital (Specify)
______ Day ____________
______ Out Patient (Specify)
INCLUSIVE DATES ____________
____________________________
6 D.) COMMUTATION
______ Requested ______ Not Requested

_______________________
Signature of Applicant
7 A.) CERTIFICATION OF LEAVE CREDITS 7 B.) RECOMMENDATION
As of _____________________ ______ Approved
_____________________ ______ Disapproved due to
_____________________ ______________________
_____________________ ______________________

Vacation Sick TOTAL

Days Days Days JUDSON M.PASTRANO


Secondary School Principal I
_________________________________
(Personnel Officer)
7 C.) APPROVED FOR: 7 D.) DISAPPROVED DUE TO
_______ Days with Pay _______________________
_______ Days without Pay _______________________
_______ Others (Specify) _______________________

Date: ________________ ______________


Signature

___________________________
Authorized Official

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