Document Code: SDO-PM-OSDS-PE

Republic of the Philippines

Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
1. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(ELEMENTARY)
3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
5. a) TYPE OF LEAVE 6. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
b) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
7. (a) CERTIFICATION OF LEAVE CREDITS 7. (b) RECOMMENDATION
As of _________________________
_______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________

VICTORIA O. MADRIGAL ________________________

Administrative Officer IV School Head
7. c) APPROVED FOR : 7. (d) DISAPPROVED

_________ Days with pay

_________ Days without pay
_________ Others (Specify)

ROMEO M. ALIP Ph.D., CESO V

Schools Division Superintendent
Authorized Official
 Document Code: SDO-PM-OSDS-PE
Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
2. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(KINDER TEACHER)
3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
8. a) TYPE OF LEAVE 9. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
c) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
10. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________

VICTORIA O. MADRIGAL ________________________

Administrative Officer IV School Head
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

ROMEO M. ALIP Ph.D., CESO V

Schools Division Superintendent
Authorized Official

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
3. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(JUNIOR HIGH SCHOOL)

3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
11. a) TYPE OF LEAVE 12. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
d) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
13. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________
 VICTORIA O. MADRIGAL ________________________
Administrative Officer IV School Head
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

ROMEO M. ALIP Ph.D., CESO V

Schools Division Superintendent
Authorized Official

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
4. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(SENIOR HIGH SCHOOL)

3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
14. a) TYPE OF LEAVE 15. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
e) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
16. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________
 VICTORIA O. MADRIGAL ________________________
Administrative Officer IV School Head
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

ROMEO M. ALIP Ph.D., CESO V

Schools Division Superintendent
Authorized Official

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
5. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(ELEMENTARY)
3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
17. a) TYPE OF LEAVE 18. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
f) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
19. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________
 VICTORIA O. MADRIGAL ________________________
Administrative Officer IV District Supervisor
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

CECILIA E. VALDERAMA, Ph.D.

OIC-Assistant Schools Division Superintendent (Elem)
Authorized Official

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
6. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(KINDER TEACHER)
3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
20. a) TYPE OF LEAVE 21. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
g) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
22. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
 _________________________

VICTORIA O. MADRIGAL ________________________

Administrative Officer IV District Supervisor
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

CECILIA E. VALDERAMA, Ph.D.

OIC-Assistant Schools Division Superintendent (Elem)
Authorized Official

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
7. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(JUNIOR HIGH SCHOOL)

3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
23. a) TYPE OF LEAVE 24. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
h) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested

______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
25. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
 Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________

VICTORIA O. MADRIGAL ________________________

Administrative Officer IV School Principal
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

MINA GRACIA L. ACOSTA

OIC-Assistant Schools Division Superintendent (Sec)
Authorized Official

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines
Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017

Name of Office: Personn

APPLICATION FOR LEAVE

CSC FORM 6
8. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)

(SENIOR HIGH SCHOOL)

3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
26. a) TYPE OF LEAVE 27. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE

_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
i) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:
 INCLUSIVE DAYS: _____________ _____ requested _____not requested
______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
28. (a) CERTIFICATION OF LEAVE 7. (b) RECOMMENDATION
CREDITS
As of _________________________ _______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________

VICTORIA O. MADRIGAL ________________________

Administrative Officer IV School Principal
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

MINA GRACIA L. ACOSTA

OIC-Assistant Schools Division Superintendent (Sec)
Authorized Official

Form 6 processing
step1 : Receive to Records Office
Step2: Forward to Personnel in Charged (Personnel
Office)

Please be guided that the attached TEMPLATE for

FORM 6 will be the official form to be used by the
whole division , and should not be revised. No
alterations and erasures. Thanks!