Republic of the Philippines

DEPARTMENT OF EDUCATION
Regional Office No. VIII (Eastern Visayas)
DIVISION OF NORTHERN SAMAR
Catarman, Northern Samar

CSC Form 6
(Revised 2015)

APPLICATION FOR LEAVE

1. Office/Agency
DepED Northern Samar
Cawayan National High School
(detailed at Galutan National High School)
2. Name:

GORDA,

RAYMOND

(Last Name)

(First Name)

3. Date of Filing:

May 2, 2016
6. a. Type of Leave
Vacation Leave
To seek employment
Forced Leave
Sick Leave
Maternity Leave
Others (Please specify)

Study Leave

Employee ID/Number:
0010819
(detailed
at
Galutan
National High School)
School/Office:
Catarman IV
District:
Employee Contact Number:
09093837760

ARNIO
(Middle Name)

4. Position:
5. Monthly Salary:

Secondary School Teacher III

Php 22,328.00

6.b. Where leave will be spent in case of Vacation Leave?

In case of Sick Leave, please specify the place of recovery.

Commutation
7.

Requested
Not Requested

Number of working days applied:

Inclusive dates: April 4, 2016 - March 31, 2017

RAYMOND A. GORDA
(Signature over Printed Name of Employee)

TERESITA C. MARINO
(Signature over Printed Name of Immediate Head)

7. A. Certification of Leave Credits

Vacation Leave
Credits

Sick Leave Credits

DETAILS OF ACTION ON APPLICATION

7. B. Recommendation
Total Leave
Credits

Vacation Leave
Credits

Administrative Officer

Sick Leave Credits

Total Leave
Credits

Administrative Officer

7. C. APPROVED FOR:

7. D. DISAPPROVED due to:

days with pay

days without pay

MANUEL P. ALBAO, CESO V

Schools Division Superintendent
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical

certificate.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period his authorized leave
of absence.