C.S.

FORM 06
APPLICATION FOR LEAVE
_________________________________________________________________________________________________
1. OFFICE: Department of Education Surname: First Name: M.I:
District/School: Amunitan ES, Gonzaga East District LOPEZ EDWIN S.
3. Date of Filling: 30-Oct-19 4. Position: 5. Monthly Salary:
Head Teacher III 33,584.00
DETAILS FOR APPLICATION

6. a TYPE OF LEAVE 6. b WHERE LEAVE WILL BE SPENT

( 1 )__x___VACATION LEAVE ( 1 ) IN CASE OF VACATION LEAVE
( ) To seek employment ( )Within the Philippines
( ) Others ( Specify) Forced Leave ( )Abroad ( Specify) _____________________

( 2 )_____SICK LEAVE ( 2 ) IN CASE OF SICK LEAVE

( 3 )_____MATERNITY LEAVE ( )In hospital ( Specify)____________________
( 4 )_____PATERNITY LEAVE ( ) Outpatient ( Specify)___________________
( 5 )_____PARENTAL LEAVE ( ) Others ( Specify) ______________________
( 6 )_____PRIVILEGE LEAVE- MC 6 ( Specify)____________
( 7 )_____MONETIZATION LEAVE______________________
( 8 )_____TERMINAL LEAVE

ADDITIONAL DATA: 6. d COMMUTATION

( ) Medical Certificate Attached ( ) Requested ( ) Not Requested
( ) Clearance Attached
( ) Others ( Specify)___________________

6. c Inclusive dates: November 4-5, 2019

Number of days applied for: 2 days

_____________________________
(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. a CERTIFICATION OF LEAVE CREDITS 7. b RECOMMENDATION
( ) APPROVAL
BALANCE AS OF _________________________ ( )Disapproval due to ____________________
________________________________________
Vacation Sick Total
Leave Balance __________ __________ __________
Less: This Leave __________ __________ __________
Leave Balance __________ __________ __________

ROSAURO C. BELEN JOSE G. TALOSIG

Personnel Officer PSDS/School Principal/Chief Admin. Officer

________________________________________________________________________________________________
7.c APPROVED FOR: 7. d DISAPPROVED DUE TO:
______________________Days w/ pay ________________________________________
______________________Days w/o pay ________________________________________
______________________Others ( Specify) ________________________________________

ORLANDO E. MANUEL, PhD, CESO V

Schools Division Superintendent
_________________
Date
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in duplicate
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going to such leave.
3. Application for sick leave filed in advance, a mewdical certificate shall accompany exceeding five (5) days. In case of medical
consultation was not availed , the apllicant should execute an affidavit.
4. an employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding to the period
of his/her unauthorized leave of absence.
5. An application for leave of absence for thirty ( 30) calendar days or more shall be accompanied by clearance from money,
and property accountabilities
 FORM 06
APPLICATION FOR LEAVE

APPLICATION FOR LEAVE

( ) To seek employment ( )Within the Philippines

( ) Others ( Specify)___________ ( )Abroad ( Specify) _____________________________

( 2 )______SICK LEAVE ( 2 ) IN CASE OF SICK LEAVE

( 3 )______MATERNITY LEAVE ( )In hospital ( Specify)___________________________
( 4 )_____________PATERNITY LEAVE ( ) Outpatient ( Specify)___________________________
( 5 )_____________PARENTAL LEAVE ( ) Others ( Specify) ______________________________
( 6 )_____________PRIVELEGE LEAVE- MC 6 ( Specify)__________________
( 7 )_____________MONETIZATION LEAVE______________________
( 8 )_____________TERMINAL LEAVE

ADDITIONAL DATA: 6. d COMMUTATION

( ) Medical Certificate Attached ( ) Requested ( ) Not Requested
( ) Clearance Attached
( ) Others ( Specify)___________________

6. c Inclusive dates: __________________________

Number of days applied for:__________________

_____________________________
(Signature of Applicant)

DETAILS OF ACTION ON APLLICATION

7. a CERTIFICATION OF LEAVE CREDITS 7. b RECOMMENDATION
( ) APPROVAL
BALANCE AS OF _________________________ ( )Disapproval due to _____________________________
_______________________________________________________
Vacation Sick Total
Leave Balance ______________________________
Less: This Leave ______________________________
Leave Balance ______________________________

______________________________________________________________________________
Personnel Officer PSDS/School Pricipal/Chief Admin. Officer

________________________________________________________________________________________________
7.c APROVED FOR: 7. d DISAPPROVED DUE TO:
______________________Days w/ pay __________________________________________
______________________Days w/o pay __________________________________________
______________________Others ( Specify) __________________________________________
 __________________________________
Schools Division Superintendent
_________________
Date
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in duplicate
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going to such leave.
3. Application for sick leave filed in advance, a mewdical certificate shall accompany exceeding five (5) days. In case of medical
consultation was not availed , the apllicant should execute an affidavit.
4. an employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding to the period
of his/her unauthorized leave of absence.
5. An application for leave of absence for thirty ( 30) calendar days or more shall be accompanied by clearance from money,
and property accountabilities
_______________