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Department ofF.dncatioa
Region lll
DIVISION OF CITY SCHOOlS
. Angeles City
!8l Jesus Street, PnhJD&bulu, Angeles City
fl Tel. No. (045) 322-5722; 888..0582/Fax Nos, 625.;9812
APPLICATION 'FOR LEAVE
NAME(LAsT)
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i DATE OF ftLING ------- SAI. .. ARY
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I I VACATION (1) In case of vacation leave:
I I TO SEF..K F.MRLOYMENT I I Within the Philippines
I I 011lERS (Pis. specifJI} J 1 .(\broad (Pls. specify)
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1 I MATERNITY .L.EA.vE
. I I 0111ERS (Pis. specify)
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l I !:quested I I Not Requested
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I SlGNAf'URil OF APJ>I,JCANT
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' {2) .In case oj'stck leave
1. I Itt Hospital (Pls. vCrlfy)
I I Out Patient
RECOMMENDAUON.
, I I APPROVED
I I DISAPPROVED DUJl TO:
PRINCIPALISCillJoL HEAD
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DBTAIL8 OP ACTION ON APPLICATION .. ..
1 CERTIFICATION LEAVE CREDITS . PREPARED BY;
! sa af
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VACATION: SICK TOTAL
i
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LIWIE G. Wf!..l
Clerkll
CERTIFIED CORRECT:
APPROVED:
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