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CSC Form6

Revised 1984
_______________________________________________________________________________________________
APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. COMPLETE NAME
Department of Education
DIVISION OF ALBAY
(Last Name) (First Name) (Middle Name)
3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

DETAILS OF APPLICATION
6. a. TYPE OF LEAVE b. WHERE LEAVE WILL BE SPENT

[ ] Vacation (1) IN CASE OF VACATION LEAVE


[ ] To seek employment
[ ] Others (Specify) [ ] Within the Philippines
_________________________ [ ] Abroad (Specify) __________________________

[ ] Sick (Specify Illness)


___________________________ (2) IN CASE OF SICK LEAVE

[ ] Maternity [ ] In Hospital (Specify) ______________________

[ ] Others (Specify)
___________________________ [ ] Out Patient (Specify) ____________________

c. COMMUTATION
Number of Working Days Applied for
[ ] Requested [ ] Not Requested
______________________________

Inclusive Dates:
______________________________
(Signature of Applicant)
______________________________
Employee No. Station No.
DETAILS OF APPLICATION
7. a. CERTIFICATE OF LEAVE CREDITS AS OF b. RECOMMENDATION

VACATION SICK TOTAL [ ] Approval

Days DaysDays [ ] Disapproved due to ___________________________

EVELYN R. LIM RIZALDE P. MESIAS


Human Resource Management Officer Public Schools District Supervisor
c. APPROVED FOR: d. DISAPPROVED DUE TO:

__________________ days with pay _________________________________


days without pay _________________________________
others (Specify) _________________________________

(Authorized Official)

INSTRUCTIONS

1. Application for vacation or sick leave for one full day or more shall be made on the Form 6 and to
be accomplished at least in duplicate.
2. Application for vacation leave shall be filed in advance of whenever possible five (5) days before
going on such leave.
3. Application for sick leave filed in advance or exceeding five (5) days shall be accompanied by a
medical certificate. In case medical consultation was not availed of, an affidavit should be
executed by the applicant.
4. An employee who is absent without approved 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 responsibilities.

October 15, 1984

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