Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Lingayen

APPLICATION FOR LEAVE

For Teaching and Non-Teaching Personnel (School)

CSC Form 6 Revised 1984

1. Office Agency 2. Name (Last) (First) (M.I.)
MALABAGO E/S BRUAN JULIE B.

3. Date of Filing 4. Position 5. Salary (Monthly)

TEACHER III Php 24,799.00
6. a) Type of Leave b) Where leave will be spent
(1) In case of vacation leave
Vacation within the Philippines
Others (Specify) ______________ _ Abroad (Specify) ______________

Sick (2) In case of Sick Leave

Maternity in Hospital (specify)______________
Others (specify) Outpatient (specify)______________

c) Number of working days d) Communication

applied for ____________
Inclusive dates requested not requested
__________________________

JULIE B. BRUAN
Signature of Applicant
7. a) Certification of Leave Credits b) Recommendation
as of ___________________ Approval ______________________
Disapproved due to ______________

Vacation Sick Total

Days Days Days

c.) Approved for d.) Disapproved due to

______________ _ __ days with pay
________ _____ ___ days without pay
___________________others
Noted:

TERESITA M. USON , Ed.D.

SCHOOL HEAD

Recommending Approval:

RAFAEL IRWIN G. NICOLAS

Administrative Officer V
APPROVED:

MARILU N. CARDENAS
Assistant Schools Division Superintendent

INSTRUCTION
1. Application for vacation or sick leave for one (1) full day or more shall be made on the form and accomplish at least in
triplicate.
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going on such leave.
3. Application for Sick leave filed in advance or succeeding five (5) days shall be accompanied by a medical certificate in
case medical consultation was not availed an affidavit should be filled by the applicant.
4. An employee who is absent without approves leave shall not be entitled to receive his/her salary corresponding to 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 a clearance from
money and property accountabilities and for endorsement addressed and duly approved by the Regional Office.