APPLICATION FOR LEAVE APPLICATION FOR LEAVE

CSC Form No. 6 CSC Form No. 6

Revised 1984 Revised 1984
1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE 1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY) 3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)

DETAILS OF APPLICATION DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT 6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT
Vacation In case of Vacation Leave Vacation In case of Vacation Leave
To seek employment Within the Philippines To seek employment Within the Philippines
Others (specify) Abroad (specify) Others (specify) Abroad (specify)

Sick In caseof Sick Leave Sick In caseof Sick Leave

Maternity - In Hospital (specify) Maternity - In Hospital (specify)
Others (specify) - Out Patient (specify) Others (specify) - Out Patient (specify)

6. c).Number of working days applied for 6. d). COMMUTATION 6. c).Number of working days applied for 6. d). COMMUTATION

Inclusive dates Requested Inclusive dates Requested

Not requested Not requested

Signature of Applicant Signature of Applicant

DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION

7. a). CERTIFICATION OF LEAVE CREDITS 7. b). RECOMMENDATION 7. a). CERTIFICATION OF LEAVE CREDITS 7. b). RECOMMENDATION
as of as of
Approved Approved
Vacation Sick Total Disapproval due to: Vacation Sick Total Disapproval due to:

Days Days Days Days Days Days

NANCY A. NOVENO NANCY A. NOVENO
LEAH MARIE MONICA K. LUMBRES Principal I LEAH MARIE MONICA K. LUMBRES Principal I
Administrative Officer V Authorized Officer Administrative Officer V Authorized Officer

7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO: 7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO:
days w/ pay days w/ pay
days w/o pay days w/o pay
others (specify) others (specify)

Balance of Leave Credits for the future use: Balance of Leave Credits for the future use:
SL = VL = SL = VL =
For and By Authority of the Schools Division Superintendent: For and By Authority of the Schools Division Superintendent:

HOMER N. MENDOZA HOMER N. MENDOZA

OIC - Assistant Schools Division Superintendent OIC - Assistant Schools Division Superintendent
(Authorized Officer) (Authorized Officer)
 INSTRUCTIONS INSTRUCTIONS

1. Application for verification of sick leave for one full day or more shall be on this form and to be accomplished 1. Application for verification of sick leave for one full day or more shall be on this form and to be accomplished
at least in duplicate. at least in duplicate.

2. Application for sick leave filed in advance or exceeding five (5) days shall be accompanied by medical 2. 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, an affidavit should be executed by the applicant. certificate. In case medical consultation was not available, an affidavit should be executed by the applicant.

GUIDELINES ON THE FILING OF APPLICATION GUIDELINES ON THE FILING OF APPLICATION

FOR VACATION LEAVE OF ABSENCE FOR VACATION LEAVE OF ABSENCE

(CSC Memorandum Circular No. 2, s. 1985) (CSC Memorandum Circular No. 2, s. 1985)

Pursuant to the Civil Service Rules, leave of absence, for any person other than serious illness of an officer Pursuant to the Civil Service Rules, leave of absence, for any person other than serious illness of an officer
1. or employee or any member of his family, must be contingent upon the needs of the service. Hence, the grant 1. or employee or any member of his family, must be contingent upon the needs of the service. Hence, the grant
vacation leave is discretionary on the part of the agency head or authority concerned, thus, mere filing of vacation leave is discretionary on the part of the agency head or authority concerned, thus, mere filing of
such leave application does not entitle an officer or employee to go on leave outright. such leave application does not entitle an officer or employee to go on leave outright.

An application for leave should properly cleared with the immediate supervisor and the Director/Department An application for leave should properly cleared with the immediate supervisor and the Director/Department
2. Heads concerned, who shall determine the contingency of the officer and employee’s service. An employee 2. Heads concerned, who shall determine the contingency of the officer and employee’s service. An employee
who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of
his unauthorized leave of absence shall not be deducted from his accredited leave credits; if there are any. his unauthorized leave of absence shall not be deducted from his accredited leave credits; if there are any.

An application for leave of absence for thirty (30) days or more shall be accompanied by a clearance. The An application for leave of absence for thirty (30) days or more shall be accompanied by a clearance. The
3. Director concerned shall see to it that the said clearance has been duly recommended by the Division Chief 3. Director concerned shall see to it that the said clearance has been duly recommended by the Division Chief
concerned before approval of such leave application of recommendation of the name of the higher concerned before approval of such leave application of recommendation of the name of the higher
authorities. authorities.

The agency should notify in writing the employee, who is Absent Without Leave (AWOL) thirty (30) days to The agency should notify in writing the employee, who is Absent Without Leave (AWOL) thirty (30) days to
4. report within five(5) days from receipt of notice, otherwise he shall be dropped from the rolls. 4. report within five(5) days from receipt of notice, otherwise he shall be dropped from the rolls.

All proposals for trips of the government officials and employees including these which are classified as all All proposals for trips of the government officials and employees including these which are classified as all
5. expenses free shall submitted to the Office if the President for final action. 5. expenses free shall submitted to the Office if the President for final action.

Before going on vacation leave of absence, the officer or employee concerned shall see to it that his Before going on vacation leave of absence, the officer or employee concerned shall see to it that his
6. application for leave was signed by proper authorities. The Personnel Officer or other Officer In-Charge 6. application for leave was signed by proper authorities. The Personnel Officer or other Officer In-Charge
thereof shall furnish the said officer or employees their copy of his/her approved or disapproved application. thereof shall furnish the said officer or employees their copy of his/her approved or disapproved application.

In the application for leave of absence, the purpose or reason thereof shall be clearly indicated and where the In the application for leave of absence, the purpose or reason thereof shall be clearly indicated and where the
7. purpose or reasons for such leave is for employment outside the country, such application shall be denied 7. purpose or reasons for such leave is for employment outside the country, such application shall be denied
outright. outright.

8. Any misrepresentation in the application for leave be ground for disciplinary action. 8. Any misrepresentation in the application for leave be ground for disciplinary action.