CSC Form No.

6
Revised 1998
APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. a) NAME (Last) (First) (Middle) 2. b) EMPLOYEE NO.
OSDS – Personnel Section
CRUZ JIMENY MIRANDA

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

June 10, 2019 Human Resource Management Officer

DETAILS OF APPLICATION
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 2. IN CASE OF SICK LEAVE

Maternity In Hospital (Specify) _________________
Paternity Out Patient (Specify) _________________
Special Leave
Force Leave 6. d) COMMUTATION
6. c) NUMBER OF WORKING DAYS Requested
APPLIED FOR: 1 day Not Requested
INCLUSIVE DATES:

MAY 21, 2019

JIMENY M. CRUZ
Signature Over Printed Name of Applicant
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION OF LEAVE 7. b) RECOMMENDATION
As of ______________________ Approved
Disapproved due to ____________________
VACATION SICK TOTAL ____________________________________

NAME OF SCHOOL HEAD/IMMEDIATE SUPERVISOR

JIMENY MIRANDA - CRUZ Signature Over Printed Name of Immediate Supervisor
Administrative Officer IV (HRMO II)
7. c) APPROVED FOR: 7. d) RECOMMENDATION
Approved
Disapproved due to __________________
________ Days with Pay _________________________________

________ Days without Pay

________ others(specify)
ARSENIO T. CORNITES, JR., CESO V
Schools Division Superintendent

For the SDS:

MARIA CORAZON C. PLASABAS, MPA

Administrative Officer V

DATE: ______

1. Application for Vacation, Sick Leave for one full day or more shall be made on this form and to be accomplished in 4 copies.
2. Application for Vacation Leave shall be filled in advance or whatever possible five (5) days before going on such leave.
3. Application for Sick Leave filed in advance or exceeding five (5) days shall be accompanied by a medical certificate. In case
medical consultation was not availed affidavit should be executed by the applicant.
4. The employee who is absent without approved leave shall not be entitled to received his/her salary corresponding to the
period of unauthorized leave of absence.
5. Application for leave of absence for thirty (30) days or more should be accomplished by a clearance of money and property
accountabilities.