APPLICATION FOR LEAVE

CSC FORM 6

Revised 1984
1. Office Agency: 2. Name (Last Name) (First) (Middle)

Department of Education/

3. Date of Filing: 4. Position: 5. Salary (Monthly)

DETAILS OF APPLICATION

6. a.) Type b.) Where leave will be spent:

1. In case of Vacation Leave
Vacation
Within the Philippines
Sick
Other (Specify)
Maternity
2. In Case of Sick Leave
Force Leave
In-Hospital (Specify)
Monetization

X
Out-Patient (Specify)
c.)Number of Working Days Applied
d.) Commutation:
__ day

X
Requested Not Requested
Inclusive Dates
_____________

_____________ _________________________

x DETAILS OF ACTION OF APPLICATION

Signature of Applicant

7. a.) Certificate of Leave Credits b.) Recommendation

as of __________________________
Vacation
Approved Sick Total
No. of Days No. of Days No. of Days
Balance `

Used
Ream.
Bal.
HOPE R. ACUESTA,ED.D
Public Schools District Supervisor

d.) DISAPPROVED DUE TO:

c.) APPROVED FOR:
_______________________________________
__________ days with pay _______________________________________
__________ days without pay _______________________________________
__________ other (specify)

________________________________________
Signature
_____________________________
Date

MAJARANI M. JACINTO, ED.D, CESE

OIC-Schools Division Superintendent
(Authorized Official)

INSTRUCTION:

1. Application for vacation or sick leave for one full day or more shall be on this form.
2. Application for vacation leave shall be filed in advance or 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 with
documentary issued by a Private Physician and their License Number should be clearly indicated.
 Republic of the Philippines
Department of Education
Region lX, Zamboanga Peninsula
Schools Division of Zamboanga Sibugay
IPIL FIELD OFFICE
IPIL HEIGHTS ELEMENTARY SCHOOL

__________________
Date

The Schools Division Superintendent

Division of Zamboanga Sibugay
Ipil, Zamboanga Sibugay

Sir:

I have the honor to request that _____ ______ ( ) days of my service credits be used to
offset my Sick Leave of Absence approved __________________. As per Division Administrative
Order No. _________ s. __________
_________ s. __________
_________ s. __________

Attached herewith are copies of my Civil Service Form 6 and Form 41 duly accomplished.

Very truly yours,

____________________
Signature of Teacher

======================================================================

1st Indorsement
Ipil Field Office
Ipil, ZS, _______________

Respectfully forwarded to the Schools Division Superintendent, Schools Division of

Zamboanga Sibugay, Ipil, Zamboanga Sibugay recommending approval of the above request.

______ ROBERT R. LEYSON_________

Elementary School Principal III
 Republic of the Philippines
Department of Education
Region lX, Zamboanga Peninsula
Schools Division of Zamboanga Sibugay
IPIL FIELD OFFICE
LUIS RUIZ SR. ELEMENTARY SCHOOL

August 17, 2016

FELIX ROMY A. TRIAMBULO, CESE

Schools Division Superintendent
Division of Zamboanga Sibugay

Sir:

I have the honor to apply for Monetization for additional funds for our House Improvement.

Hoping that this request will merit your kind approval.

Thank you and More Power!

Very truly yours,

BRENDA S. MONTANO
Elem. School Principal ll