CSC Form No.

6 (Revised 1985)

APPLICATION FOR LEAVE

(for TEACHERS)

TYPE OF LEAVE
Name :

[ ] Sick Leave:
Signature :
[ ] Out Patient
Position : [ ] In Hospital (Please specify)

Monthly Salary : [ ] Maternity Leave

[ ] Paternity Leave
Office/ School : Cabantian National High School
[ ] Calamity Leave
Date of Filing : [ ] Rehabilitation Leave
No. of Working Days Applied for : [ ] Solo Parents Leave (Specify reason of the leave)
Inclusive Dates :

[ ] Study Leave
Commutation : [ ] Requested [ ] Magna Carta for Women Leave
[ ] Not Requested [ ] Anti-VAWC Leave (RA 9262)
[ ] Personal Leave (Please specify)

FOR PERSONNEL SECTION ONLY ACTION ON APPLICATION

VSC Recommending :
Leave Credits balance as of: [ ] Approval
[ ] Disapproval due to:

This leave
LIBERTY L. RASGO-ARELLANO, Ed.D.
Immediate Supervisor
Balance

[ ] Approved for:
Certified by: day/s with pay
day/s without pay
[ ] Disapproved due to:
ROMEL L. TAMBIS
Administrative Officer IV/ HRMO II
MARIA INES C. ASUNCION, CESO V
Schools Division Superintendent
CSC Form No. 6 (Revised 1985)

APPLICATION FOR LEAVE

(for NON-TEACHING PERSONNEL)

TYPE OF LEAVE
Name : JOY V. SANDIEGO

[ P ] Vacation Leave
Signature :
[ P ] Within the country
[ ] Abroad : _____________________
Position : Senior Bookkeeper
[ ] Sick Leave:
[ ] Out Patient
Monthly Salary : P 16,986.00
[ ] In Hospital (Please specify)

Office/ School : Cabantian National High School

[ ] Forced Leave
[ ] Compensatory Overtime Credit/ CTO
Date of Filing : February 24, 2017
[ ] Maternity Leave
[ ] Paternity Leave
No. of Working Days Applied for : 1 day only
[ ] Calamity Leave
[ ] Rehabilitation Leave
Inclusive Dates : February 16, 2017
[ ] Solo Parents Leave (Specify reason of the leave)

[ ] Study Leave
Commutation : [ ] Requested [ ] Magna Carta for Women Leave
[ ] Not Requested [ ] Anti-VAWC Leave (RA 9262)
[ ] Special Leave (Please specify)
Daughter's birthday

FOR PERSONNEL SECTION ONLY ACTION ON APPLICATION

VL SL Recommending :
Leave Credits balance as of: [ ] Approval
[ ] Disapproval due to:

This leave
WELITO I. ROSAL
Immediate Supervisor
Balance

[ ] Approved for:
Certified by: day/s with pay
day/s without pay
[ ] Disapproved due to:

ROMEL L. TAMBIS
Administrative Officer IV/ HRMO II MARIA INES C. ASUNCION, CESO VI
Schools Division Superintendent