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CSC Form No.

6
Revised 1984

APPLICATION FOR LEAVE

1. OFFICE AGENCY 2. NAME (LAST) (FIRST) (MIDDLE)


DEPED-DANAO CITY GABUTAN RHEY F.
3. DATE OF FILING 4. POSITION / LEVEL 5. SALARY (MONTHLY)
January 28, 2019 TEACHER III
DETAILS OF APPLICATIONS
6. (A) TYPE OF LEAVE 6. (B) WHERE LEAVE WILL BE SPENT
VACATION (1) IN CASE OF VACATION LEAVE
To seek employment Within the Philippines
Others (Please Specify) Abroad (Please Specify)

✔ SICK (2) IN CASE OF SICK LEAVE


MATERNITY In Hospital (Please Specify)
SPL
Other (Please Specify) ✔ Out Patient (Please Specify)

6. (C) NUMBER OF WORKING DAYS 6. (D) COMMUTATION


APPLIED FOR 1 day Requested
25-Jan-19 Not Requested

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. (A) CERTIFICATION OF LEAVE CREDITS 7. (B) RECOMMENDATION


As of For Approval
For Disapproval due to

VACATION: SICK: TOTAL:

Days Day Days


MARIBETH E. NOYA
School Head

MA. MONINA L. PATOLTOL


HRMO
MA. CONCEPCION E. BATULAN
PSDS/EPS

7. (C) APPROVED FOR: 7. (D) DISAPPROVED DUE TO:


day/s with pay
day/s without pay
others (Please Specify)

ROSELLER N. GELIG, CESO VI


OIC - Schools Division Superintendent

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