A.

CSC Form 6 APPLICATION FOR LEAVE

1. Office/Agency 2. NAME: (Last) (First) (Middle)

3. Date of Filing 4. Position 5. Monthly Salary

______________________________________________________________________________________________

DETAILS OF APPLICATION

6. A.) TYPE OF LEAVE B.) WHERE LEAVE WILL BE SPENT

Vacation In case of vacation leave

To seek employment Within the Philippines

Other (Specify) Abroad (Specify)

_______________________________ ________________________________

Sick In Hospital (Specify)

Paternity Out-Patient (Specify)

Maternity

Other (Specify) _________________________________________________________________

C.) NUMBER OF WORKING DAYS D.) COMMUTATION

APPLIED FOR ________________________
Inclusive Dates: _______________________ Requested Not Requested

______________________________
Signature of Applicant

7. A.) CERTIFICATE OF LEAVE CREDITS B.) RECOMMENDATION

AS OF __________________________

Vacation Sick Total Approved

Disapproved due to ________________

AMELIA R. DEAN MARIVIC G. VELGADO

Administrative Officer V (Authorized Official)

C. RECOMMENDATION

Approved Disapproved
________________________________________________________________________________________

D. APPROVED FOR: E.) DISAPPROVED DUE TO:

______________days with pay ___________________________________
______________days without pay ___________________________________
______________other (specify) ___________________________________

LERMA LABRADOR FLANDEZ

Officer In-Charge
Office of the Assistant Schools Division Superintendent