CSC FORM 6
APPLICATION FOR LEAVE
1.Office/Agency Name (Last) (First) (Middle)
(School Assignment)
2. Date of Filing Position Salary
DETAILS OF APPLICATION
3. a) Type of Leave 4. b) Where Leave will be spent:
____ Vacation (1) In case of Vacation Leave
____ To seek employment ____ Within the Philippines
____ Others (Specify) ____ Abroad (Specify)
______________________________ _________________________________________
____ Sick (2) In case of Sick Leave
____ Maternity In Hospital (Specify) _________
____ Others (Specify) _____________ Out Patient (Specify) _________
5. c) Number of Working Days Commutation
Applied for _______________ ____ Requested
Inclusive Dates _________________ ____ Not Requested
__________________
___________________________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
6. a) Certification of Leave Credits 7. b) Recommendation:
as of:
______________________________________________
Approval
Vacation Sick Total Disapproval due to _____________________
_____________________________________________
___________________________________
MARIA NICHOLETTE C. ROJO Authorized Official
Administrative Officer IV
8. c) APPROVED FOR: 9. d) DISAPPROVED DUE TO
_________ day/s with pay ______________________________________
_________ day/s without pay
_________ Others (specify) ________________
APPROVED:
MAYLENE M. MINIMO, Ed. D., CESE
OIC – Assistant Schools Division Superintendent