REPUBLIC OF THE PHILIPPI NE S

DE P ARTMENT OF EDUCATION

R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN
Form 6

APPLICATION FOR LEAVE

1. Office / Agency 2. Name (Last) (First) (Middle)
Mariveles NHS - Poblacion Tabbun Jonathan Pangaliman
3. Date of Filing 4. Position 5. Salary
March 13, 2017 Teacher III P
DETAILS OF APPLICATION
6. (a) Type of Filing 6. (b) Where Leave will be spent
Vacation (1) In case of Vacation Leave
To Seek Employment Within the Philippines
Others (specify) Abroad (Specify)

Sick (2) In case of Sick Leave

Maternity In Hospital (Specify)
Others (specify)
Out Patient (Specify)
6. (c) Number of Working Days applied for: `
3 Day(s) 6. (d) Commutation
Inclusive Dates: Requested
From To Not Requested
mm dd yyyy mm dd yyyy
03 08 2017 03 10 2017

Name and Signature of Applicant

7. (a) Certification of Leave Credits 7. (b) Recommendation
as of: Approval
Vacation Sick Total Disapproval due to

ROSHENAR V. CRUZ
Administrative Officer IV Authorized Official
7. (c) Approved for: 7. (d) Disapproved due to
days with pay
days without pay
others (specify)

APPROVED:

ROLAND M. FRONDA, Ed.D.

OIC-Assistant Schools Division Superintendent

for Teaching and Non-Teaching Personnel with less than 30 days leave