C.S.

FORM 6
REVISED 1984
Employee No. _________________

APPLICATION FOR LEAVE

1. Office / Agency
DepEd Carcar City Division
2. Name
____________________________________________________________________________________________________________________________________________________________

Elementary (Last) (First) (Middle)

Secondary School: _____________________

3. Date of Filing 4. Position 5. Salary ₱1,029,010.00

DETAILS OF APPLICATION
6. A. Type of Leave 6. B. Where Leave will be spent
Vacation Leave (1) In case of Vacation Leave
To seek employment Within the Philippines
Others (Specify) Abroad (Specify)
___________________________ _________________________________
Sick Leave (2) In case of sick leave
In Hospital (Specify) ______________
Paternity Leave Out Patient (Specify) _______________

Others (Specify) _______ __________________________________

6. C. Number of Working days applied: 6. D. Computation
____ day with pay Requested Not Requested
Inclusive dates: ____________

__________________
Signature of Applicant
DETAILS OF ACTION OF APPLICATION
7. A. Certification of Leave as of ___________ 7. B. Recommendation
________________________ Approved Disapproved due to
_____________________________ ________________
Vacation Sick Total
Days Days Days

____________________________________

_____________________________________________
EDGARDO BERNASOL
Administrative Office - OIC
_____________
7. C. APPROVED FOR 7. D. DISAPPROVED DUE TO
________ days with pay _______________________________
________ days without pay _______________________________
________ others (Specify)

________________ SENEN P. PAULIN, CESO V

Date Schools Division Superintendent

1. Application for vacation or sick leave for one full day or more should be made in this form and to be accomplished at least in duplicate.
2. Application for vacation leave shall be filed in advance or whenever possible for 5 days before going on vacation leave.
3. Application for sick leave be filed in advance or for exceeding five (5) days shall be accompanied by a medical certificate. In case medical certification for
consultation is not available, an affidavit must be executed by the applicant.