APPLICATION FOR LFAVE
CSC FORM 6
Revised 1986 S
[1 OFFICE/AGENCY 2. NAME (Last} (First) (Middle) 1
Depéd-Division of Marinduque |
3. DATE OF FILING “4, POSITION. 5. SALARY
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6, b) WHERE LEAVE WILL BE SPENT é
vacation 1, IN CASE OF VACATION LEAVE 5
__ To sezk employment within the Philippines
Others (specify) = __ Abroad (specify)
Sick 2, INCASE OF SICK LEAVE
‘Maternity in Hospital (specify)
_others = Out Patient (specify)
6. ¢) NUMBER OF WORKING DAYS 6. d) COMMUTATION
APPLIED FOR eee __ Requested
INCLUSIVE DATES Not Requested
Squealer =
DETAILS OF ACTION ON APPLICATION =
7-3] CERTIFICATION OF LEAVE 7.8) RECOMMENDA TION
CREDITSASOF 2 + Approval
= Disapproval
vacation Sick Total
MARIDELLE. HERMOSA ha
‘Administrative Officer IV School Head/Principal/District Supervisor
7c) RECOMMENDATIC
Approval Disapprovel _
MAY BERNADETH O. DELA ROSA
Administrative Officer V
7, d] APPROVED FOR = 7, €] DISAPPROVED DUE TO
_ Days with Pay
EE Days without Pay
Others (specify)
CARLITO M. MATIBAG, Ph.0.
Officer-in-Charge
Office of the Schoo!s Division Su
intendentAPPLICATION FOR LEAVE.
Eom
aa
T OFFICe/AGENET THANE TT al Taare
GUELoN aot Anon ica as
PORTE OF FLING TFOSTION SSR
DETAILS OF APPLICATION
6a) TPE oF Leave 6.2) WHERE Leave iu BESPENT
ee INCASE OF VACATION LEAVE
Fear tae within the Pipines
teat Grae a Ree Geet
tek 2. INCASE OF SICK LEAVE
nerity * resale ieee}
tt uae recs
6. «) NUMBER OF WORKING DAYS 6.6) coMMUTATION
A29UIE0 FOR = Tene
INCLUSIVE DATES Sean tegen
= | nog Sil Gier
REOANTE Rei pice: