CSC Form 6 Use this form for Senior High School
Revised 1998
APPLICATION FOR LEAVE
1. School (SHS) 2. Name (Last) (First) (Middle)
3. Date of Filing 4. Position 5. Salary
DETAILS OF APPLICATION
6. A) Type of Leave 6. 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)
6. C) Number of Working Days applied for: 6. D) Commutation
Requested Not Requested
Inclusive Dates
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of
Approval
Vacation Sick Total Disapproval due to
days days days
DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay
Signature
Rowena T. Quiambao, CESE
OIC- Asst. Schools Division Supt. (Secondary)
Date: _________________
CSC Form 6
Revised 1998
APPLICATION FOR LEAVE
1. Office/Agency/School 2. Name (Last) (First) (Middle)
3. Date of Filing 4. Position 5. Salary
DETAILS OF APPLICATION
6. A) Type of Leave 6. 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)
6. C) Number of Working Days applied for: 6. D) Commutation
Requested Not Requested
Inclusive Dates
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of
Approval
Vacation Sick Total Disapproval due to
days days days
DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay
Signature
Rowena T. Quiambao, CESE
OIC- Asst. Schools Division Supt. (Secondary)
Date: _________________
CSC Form 6
Revised 1998
APPLICATION FOR LEAVE
1. Office/Agency/School 2. Name (Last) (First) (Middle)
3. Date of Filing 4. Position 5. Salary
DETAILS OF APPLICATION
6. A) Type of Leave 6. 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)
6. C) Number of Working Days applied for: 6. D) Commutation
Requested Not Requested
Inclusive Dates
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of
Approval
Vacation Sick Total Disapproval due to
days days days
DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay
Signature
LEONARDO C. CANLAS,Ed.,D.CESE
OIC-Asst. Schools Division Superintendent
Date: _________________
CSC Form 6 Use this form for Travel Abroad Only
Revised 1998
APPLICATION FOR LEAVE
1. Office/Agency/School 2. Name (Last) (First) (Middle)
3. Date of Filing 4. Position 5. Salary
DETAILS OF APPLICATION
6. A) Type of Leave 6. 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)
6. C) Number of Working Days applied for: 6. D) Commutation
Requested Not Requested
Inclusive Dates
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of
Approval
Vacation Sick Total Disapproval due to
days days days
DEXTER E. PANGILINAN Leonardo D. Zapanta, Ed.D. CESO VI
Administrative Officer - IV OIC- Schools Division Supt.
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay
Signature
Nicolas T. Capulong, Ph.D., CESO VI
Asst. Regional Director, OIC
Date: _________________
CSC Form 6
Revised 1998
APPLICATION FOR LEAVE
1. Office/Agency/School 2. Name (Last) (First) (Middle)
3. Date of Filing 4. Position 5. Salary
DETAILS OF APPLICATION
6. A) Type of Leave 6. 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)
6. C) Number of Working Days applied for: 6. D) Commutation
Requested Not Requested
Inclusive Dates
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of
Approval
Vacation Sick Total Disapproval due to
days days days
DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay
Signature
ZENIA G. MOSTOLES.Ed.D.,CESO V
Schools Division Superintendent
Date: _________________
