Republic of the Philippines

CSC Form No. 6 Department of Education

Revised 1984 Region VIII
Division of Biliran
District of Kawayan
INASUYAN INTEGRATED SCHOOL

APPLICATION FOR LEAVE

1. OFFICE AGENCY 2. NAME (Last) (First) (Middle)

3. DATE OF FILING 4. POSITION 5. SALARY (monthly)

6. a.) Type of leave 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 Leave 2.) In case of sick leave
( ) Maternity Leave ( ) In Hospital (Specify) _________________
( ) Others (Specify) ( ) Out Patient (Specify) _________________
( ) Personal Leave

6. c.) Number of working Days applied for 6. d.) Communication

_______________________________ ( ) Requested ( ) Not Requested

Inclusive Dates

_______________________

___________________________________
(Signature of Applicant)
__________________________________________________________________________________________________

DETAILS OF ACTION ON THE APPLICATION

7. A.) CERTIFICATION OF LEAVE CREDITS 7.b.) Recommendation

As of________________ 20_____ ( ) Approved

( ) Disapproved due to ____________________
VACATION SICK TOTAL ________________________________________
___________ _____ _______

ALLAN PAUL U. TUBIS LUZVIMINDA R. A. FLORES

Division Administrative Officer (School Head )

7. c.) Approved for: 7.d.) Disapproved due to:

____________________________ Days ___________________________________________

____________________________ Days without pay ___________________________________________
____________________________ Others (Specify) ___________________________________________

PEDRO T. ESCOBARTE, Ph. D., CESO V, CSEE, CEO VI

Schools Division Superintendent
____________________________________________________________________________________________________________
1. Application for Vacation and sick leave for one full day or more shall be made on this form and to be accomplished at least in duplicate.
2. Application for Vacation Leave shall be filled in advance or whether five (5) days before going on such leave.
3. Application for Sick Leave filed in advanced or exceeding five (5) days shall be accompanied by a medical certificate.
4. An employee who is absent without approved leave shall be entitled to receive a salary corresponding to the periods of his authorized leave of absence.
5. An applicant for leave for thirty or more calendar days shall be accompanied by a clearance from money and property responsibilities.