DEPARTMENT OF EDUCATION

Region X - Northern Mindanao

DIVISION OF BUKIDNON
Sumpong, Malaybalay City
www.depedbukidnon.net.ph

APPLICATION FOR LEAVE

CSC Form 6
(Revised 2015)
1. Office/Agency
DepED - Division of Bukidnon

Employee ID/Number:
School/Office:
District:
Employee Contact Number:

2. Name:
(Last Name)

(First Name)

3. Date of Filing:

4. Position:
5. Monthly Salary:

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

6.b. Where leave will be spent in case of Va

In case of Sick Leave, please specify the pl

Commutation
7.

Number of working days applied:

Inclusive dates:

(Signature over Printed Na

(Signature over Printed Name

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

ADOLFO T. TORRES
Administrative Officer V
7. C. APPROVED FOR:
days with pay
days without pay

JESNAR DEMS S. TORRES. Ph. D.

OIC - 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 copi

2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with m

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

Number:

(Middle Name)

in case of Vacation Leave?

specify the place of recovery.

Requested
Not Requested

ver Printed Name of Employee)

Printed Name of Immediate Head)

ION
ndation
Sick Leave Credits

Total Leave Credits

7. D. DISAPPROVED due to:

.
nt

ished in four copies.

companied with medical certificate.

the period his authorized leave of absence.