CSC Form No.

6
Revised 1999
APPLICATION FOR LEAVE
2. Name

1. Office/Agency
DepEd/Division of Aklan
3. Date of Filling

(First)
(Middle Initial)
Abe Joy
S
5. Salary (Monthly)

4. Position
January 26, 2015

Principal I
6. C.) Where Leave will be Spent
1. In Case of Vacation Leave
(
) Within the Philippines
(
) Abroad (specify)

6. A.) Type of Leave

( / ) Vacation
(
) Sick
(
) To seek employment
(
) Others (Specify)

6. D.) Commutation
(
) Requested

6. B.) Number of Working Days Applied for

3 days
Inclusive Days:

(Last)
Isaran

) Not Requested

January 28-30, 2015

Signature of Applicant
Details of Action Application
7. B.) Recommendation

7. A.) Certification of Leave Credits

as of
VACATION

SICK

TOTAL

( ) Approval

KENNETH B. REVESTIR
Public Schools District Supervisory

7. C.) Approved for:

7. D.) Dissapproved due to:

Days with pay
Days without pay
Others (Specify)

Approved by:

Dr. JESSE M. GOMEZ, CESO V

Schools Division Superintendent
Date :

Note:
1. Application for vacation leave or sick leave for one full day or more shall be made on this form to be accomplished
at least in duplicate.
2. Application for vacation 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 days shall be accompanied by a medical certificate.
in case of medical certificated was not availed, an affidavit should be executed be the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the
period of his unauthorized leave of absence.
5. An application for leave of absence of thirty 30 calendar days to more shall be accomplished by a clearance from

money anf property accountability.

CSC Form No. 6

Revised 1999

APPLICATION FOR LEAVE

1. Office/Agency

2. Name

(Last)

3. Date of Filling

4. Position

(First)

(Middle Initial)

5. Salary (Monthly)

Principal I

DETAILS OF APPLICATION
6. a.) TYPE OF LEAVE
[
[
[

:
:
:
:
:
:
:
:
:
:
:
:

] Vacation
] To seek employment
] Others (Specify)

[ / ] Force Leave
[
] Sick
[
] Maternity
6. c.) NUMBER OF WORKING DAYS
APPLIED FOR

INCLUSIVE DATES:

6. b.) WHERE LEAVE WILL BE SPENT:

1.IN CASE OF VACATION LEAVE
[
[

] Within the Philippines

] Abroad (specify)

2. IN CASE OF SICK LEAVE

[
] In Hospital (Specify)
[
] Out of Patient (Specify)

6. d.) COMMUTATION
[

] Requested

:
:
:
:

] Not Requested

(Signature of Employee)

DETAILS OF ACTION APPLICATION

7. a.) CERTIFICATION OF LEAVE CREDITS
As of
20

7. b.) RECOMMENDATION

Vacation = Sick = Total

=
=
=
=
=
=
Days
Days
Days

Balance
Less this Leave
Balance

] Approval

] Disapproval due to

Public Schools District Supervisor

(Authorized Officer)

(Personnel Officer)

7. c.) APPROVED FOR:

7. d.) DISAPPROVED DUE TO:

Days with pay
Days without pay
Others (Specify)

(Signature)

(Authorized Official)

Date :