CSC Form 6

Revised 1998
APPLICATION FOR LEAVE
1. Office/Agency 2. Name (Last) (First) (Middle)
Toril ES-DepEd Mis. Occ. ORIGENES LOREVIC CORONEL
3. Date of Filing 4. Position 5. Salary
Teacher 1 P 20, 120.00
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 Within the Philippines
Others (Specify) Abroad (Specify)
CANADA
Sick 2. In case of Sick Leave
Maternity In hospital (Specify)
Others (Specify)

6. C) Number of Working Days applied for: 6. D) Commutation

Requeste Not Requested
Inclusive Dates

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of

Vacation Sick Total Approval

Disapproval due to
days days days

ANN D. TUAL
Authorized Official Authorized Official
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

AGUSTINES E. CEPE,Ph. D., CESO V

Schools Division Superintendent

Date: _________________