APPLICATION FOR LEAVE

CSC FORM NO.6

Revised 1984

1. Office / Agency
Department of Education
Barra Elementary School

2. Name

3.

4. Position

Date of Filling

( last)

(First)

( Middle)

5. Salary

6. DETAILS OF APPLICATION
6.a). Type of Leave
6. b.) Where Leave will be spent
_________ Vacation Leave
1. In case of Vacation Leave
_________ To seek employment
____ Within the Philippines
_________ Others ( specify)
____ Abroad ( specify)
_________ Sick Leave
2. In case of sick leave
_________ Maternity Leave
____ In Hospital ( specify)_______
_________ Others ( specify)__________
____ Out Patient ( specify) ______
________________________
6. d) Accommodation
6. c). No. of Working Days Applied for
____ Requested _______ Not Requested
Inclusive dates:

_________________
Signature of Applicant

7. DETAILS OF ACTION ON APPLICATION

7.a. Certification of Leave Credits
7.b) Recommendation
As of
VACATION
SICK
TOTAL
______ Approved
______ Not Approved due to_________
Previous Balance
Less
Remaining Balance
DAYS

DAYS

7.c.) Approved for

_________ Days with pay
_________ Days without pay
_________ others ( specify)

DAYS

MARIA ASUNCION G. RAFOLS

Principal 1
Authorized Official
7. d) Disapproved due to:
___________________________
___________________________

________________________
Signature
_________________
Date

______________________
Authorized Official

1. Application for Vacation Leave or Sick Leave for one full day or more shall be made in the form and to
be accomplished at least in duplicate.
2. Application for vacation leave shall be filled in advance or whenever possible ( 5) days before going to
such leave
3. Application for sick leave filled in advance or succeeding five(5) days shall be accompanied by medical
Certificate. In case Medical consultation was not availed of an affidavit should be excused by then.
4. An employee who is absent without approved leave shall not be entitled to receive his/her salary
corresponding to the period of his/her salary authorized leave of absence.
5. An application of leave of absence for thirty (30) calendar days or more shall be accompanied by a
6. clearance from money and property accountability.