CS Form 6

APPLICATION FOR LEAVE

1. OFFICE AGENCY 2. NAME: (Last) (First) (Middle)
DepEd
3. DATE OF FILLING 4. POSITION SALARY (Monthly)
Php._____________________________
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE BE SPENT:

_______ Vacation (1) IN CASE OF VACATION LEAVE

_______ To seek employment _______ Within the Philippines

_______ Others (Specify) _______ Others (Specify)

_______ Sick (2) IN CASE OF SICK LEAVE

_______ Maternity _______ Hospital (Specify)
_______ Others (Specify) _______ Out Patient (Specify)

6. c) NUMBER OF DAYS 6. d) COMMUTATION

APPLIED FOR _______ _______ Requested _______
INCLUSIVE DATES ______________________

_______________________________________
(Signature of Applicant)
Employee No. ___________________________
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
AS OF ___________________________ _______ Approval
_______ Disapproval due to ________________
Vacation Sick Total ________________________________
_______ _______ _______

_______________________________________
(Principal)
______________________________________
Administrative officer

7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO:

_______ days with pay _______________________________________
_______ days without pay _______________________________________
_______ others (Specify)

Date: _________________________________

JOSE L. DONCILLO, CESO V

Schools Division Superintendent

1. Application for vacation or sick leave for one full day or more shall be made on the Form and to be accomplished in
duplicate.

2. application for vacation leave shall be filled in advance of whenever possible five (5) days before going on such leave.

3. application for sick leave filed in advance or exceeding five (5) days shall be accomplished by medical certificate. In
case medical consultation were not availed of, an affidavit should be executed by the applicant.

4. an employee who is absent without approved leave shall not entitled to receive his salary corresponding the period of
his unauthorized leave of absence.

5. an application for leave of absence for thirty (30) calendar days or more shall be accomplished by a clearance form
money.