CS FORM NO.

6
Revised 1984

APPLICATION FOR LEAVE

1. OFFICE/DISTRICT 2. NAME (LAST) (FIRST) (MIDDLE)

SAN GABRIEL DISTRICT MACATO VENUS VERGARA
3. DATE OF FILING 4.POSITION 5. SALARY (MONTHLY)
OCTOBER 17, 2019 TEACHER III P 25, 232.00
DETAILS OF APPLICATION
6. A) TYPE OF LEAVE B) WHERE LEAVE WILL BE SPENT

Vacation (1) IN CASE OF VACATION LEAVE

To seek employment
Other (specify) Within the Philippines
_______________________ Abroad (specify)
____________________________
(2) IN CASE OF SICK LEAVE
√ Sick In Hospital (specify) ____________
Maternity _____________________________
Others (specify) √ Out Patient (specify)
____________
____ _________ San Gabriel Lying In
C) NUMBER OF WORKING DAYS APPLIED FOR D) COMMUTATION
_________________1___DAY____________
Inclusive: ____OCTOBER 18, 2019_ √ Requested Not Requested

____________________________
(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION Employee No. 4191259

7. A) CERTIFICATION OF LEAVE CREDITS B) RECOMMENDATION

As of ____________________________________ Approval __________________________

Vacation Sick Days Disapproval due to __________________

__________________________________
__________________________________

DOMINGA N. LIM PRISCILA G. COY-OM

Administrative Officer/Personnel Officer Head Teacher III
7. C. APPROVED FOR 7. D. DISAPPROVED
____________________
_______ day withdays
paywith pay ______________________________________
______________ days without pay
______1_______ day without pay(offset by service credits) ______________________________________
______________
______________ Others
days other (specify)
(specify) ______________________________________

DR. MARCIANO U. SORIANO

Assistant Schools Division Superintendent
Approving Authority