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CSC Form 6

This document is a CSC Form 6 application for leave from an office or agency. It collects information such as the applicant's name, position, salary, type of leave being requested (e.g. vacation, sick, maternity), dates of leave, and number of leave days. It requires signatures from the applicant and authorizing officials, and notes the applicant's current leave balances and whether the request is approved or disapproved. Instructions at the bottom specify the process for applying for different types of leave, including needing a medical certificate for sick leave over 5 days or an affidavit if no medical consultation.

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Eurika Lage Ni
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100 views1 page

CSC Form 6

This document is a CSC Form 6 application for leave from an office or agency. It collects information such as the applicant's name, position, salary, type of leave being requested (e.g. vacation, sick, maternity), dates of leave, and number of leave days. It requires signatures from the applicant and authorizing officials, and notes the applicant's current leave balances and whether the request is approved or disapproved. Instructions at the bottom specify the process for applying for different types of leave, including needing a medical certificate for sick leave over 5 days or an affidavit if no medical consultation.

Uploaded by

Eurika Lage Ni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CSC FORM 6

APPLICATION FOR LEAVE

Office/Agency Name (Last) (Given) (Middle)

Date of Filing Position Monthly Salary

Type of Leave Where Leave was/will be spent:


Vacation If VL: Local Abroad, country:____
Sick If SL: Out-patient In-patient:____
Maternity
Special
Others:____________ Reason for Leave:__________________________________

No. of Days: Monetization


__________________ No. of Days: 10 to 30 days:________
50% or more: ________

Inclusive Date/s:
__________________ Purpose:______________________________________

____________________________
Signature of Applicant
Details of Action on Application
Certification of Leave Credits Recommendation
as of: __________________ Approval
Disapproval
Reason: ______________
Vacation Sick Total
Beg. Balance
Less
End Balance
___________________________
Authorized Signature
FRANCISCO A. ANCHOJAS
Administrative Officer V

Approved for: Disapproved due to:


___________ days with pay _____________________________
___________ days without pay _____________________________

THELMA C. QUITALIG, Ph.D., CESO V


Schools Division Superintendent

1. Application for leave or sick leave for one full day or more shall be made on the form and to be accomplished in
duplicate.
2. Application for vacation leave shall be filled in advance or whenever possible five (5) days before going on such
leave.
3. Application for sick leave filled in advance or exceeding five (5) days shall be accompanied by a medical certificate.
In case medical consultation were not availed of, an affidavit should be executed by the applicant.
4. An employee who is absent without approved leave shall not entitled to receive his salary corresponding the period
of his unauthorized leave of absence.
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by clearance from
money, property accountability, and Special order.

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