Form 6

Revised 1984
APPLICATION FOR LEAVE
1. OFFICE/ AGENCY NAME (Last) (First) (Middle)

DepEd, Minalabac District

3. DATE OF FILLING 4. POSITION 5. SALARY

___________________ _______________ _______________

DETAILS OF APPLICATION
6. (a) TYPE OF LEAVE 6. (b) WHERE LEAVE WILL BE SPENT
_____ vacation (1) IN CASE OF VACATION LEAVE
______To seek employment
______Others (Specify) __________
______ Within the Philippines
_______Abroad (Specify) _________
_______Sick (2) IN CASE OF SICK LEAVE
_______ Maternity In Hospital (Specify) _______
_______ Others (Specify) ____________ Out Patient (Specify) ______

© NUMBER OF WORKING DAYS (d) COMMUTATION

APPLIED FOR: _______________ ____Requested ____ Not Requested

INCLUSIVE DATES: ___________

____________________________
(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. (a) CERTIFICATIONOF LEAVE CREDITS 7. (b) RECOMMENDATION

AS OF ___________________________ _____ Approved
_____ Disapproved to _____
Vacation Sick Total

Days Days Days

MA. DIVINA H. CALLEJA ROMEL S. CASASOLA

Personnel Officer Principal
(Authorized Official)

7. (c) APPROVED 7. (d) DISAPPROVED DUE TO: ________

______ days with pay ______________________________
______ days without pay
______ Others (specify)
DOLORES Q. MAPUSAO
(Signature)
(Authorized Official)
INSTRUCTIONS
1. Application for vacation or sick leave for one full day or more shall be made this form and be accomplished at least in duplicate.
2. Application for leave shall be filled in advance or wherever possible five days before going on such leave.
3. Application for sick leave filed in advance or exceeding five (5) days shall be accompanied by medical certificate. In case medical
consultation was not available, the applicant should execute an affidavit.
4. An employee who is absent without approved leave shall not be entitled to received his/her salary corresponding to the period of his
authorized leave of absence.
5. An applicant for leave of absence for 30 calendar days or more shall be accompanied for clearance for money and property responsibility.

Form 6
Revised 1984
 APPLICATION FOR LEAVE
1. OFFICE/ AGENCY NAME (Last) (First) (Middle)

DepEd, Minalabac District

3. DATE OF FILLING 4. POSITION 5. SALARY

___________________ _______________ _______________

DETAILS OF APPLICATION
6. (a) TYPE OF LEAVE 6. (b) WHERE LEAVE WILL BE SPENT
_____ vacation (1) IN CASE OF VACATION LEAVE
______To seek employment
______Others (Specify) __________
______ Within the Philippines
_______Abroad (Specify) _________
_______Sick (2) IN CASE OF SICK LEAVE
_______ Maternity In Hospital (Specify) _______
_______ Others (Specify) ____________ Out Patient (Specify) ______

© NUMBER OF WORKING DAYS (d) COMMUTATION

APPLIED FOR: _______________ ____Requested ____ Not Requested

INCLUSIVE DATES: ___________

____________________________
(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. (a) CERTIFICATIONOF LEAVE CREDITS 7. (b) RECOMMENDATION

AS OF ___________________________ _____ Approved
_____ Disapproved to _____
Vacation Sick Total

Days Days Days

MA. DIVINA H. CALLEJA ROMEL S. CASASOLA

Personnel Officer Principal
(Authorized Official)

7. (c) APPROVED 7. (d) DISAPPROVED DUE TO: ________

______ days with pay ______________________________
______ days without pay
______ Others (specify)
DOLORES Q. MAPUSAO
(Signature)
(Authorized Official)
INSTRUCTIONS
6. Application for vacation or sick leave for one full day or more shall be made this form and be accomplished at least in duplicate.
7. Application for leave shall be filled in advance or wherever possible five days before going on such leave.
8. Application for sick leave filed in advance or exceeding five (5) days shall be accompanied by medical certificate. In case medical
consultation was not available, the applicant should execute an affidavit.
9. An employee who is absent without approved leave shall not be entitled to received his/her salary corresponding to the period of his
authorized leave of absence.
10. An applicant for leave of absence for 30 calendar days or more shall be accompanied for clearance for money and property responsibility.