Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 2

Document Code: SDO-PM-OSDS-PE

Republic of the Philippines


Region III Revision: 00
Schools Division Office of Bulacan
Effectivity date: 11-16-2017
Name of Office: Personn
APPLICATION FOR LEAVE
CSC FORM 6
1. OFFICE / AGENCY 2. NAME (LAST) (FIRST) (MI)
ST. MARTHA ELEMENTARY SCHOOL -
BOCAUE DISTRICT
(ELEMENTARY)
3. Date of Filing: 4. Position: Salary

DETAILS OF APPLICATION
5. a) TYPE OF LEAVE 6. WHERE LEAVE WILL BE SPENT
_______ Vacation a) IN CASE OF VACATION LEAVE
_______ To seek employment _________Within the Philippines
Others (Specify) _________ _________ Abroad (Specify) _______
______________________ _____________________

_______ Sick b) IN CASE IF SICK LEAVE


_______ Maternity _______ In Hospital (Specify)______
_______ Others _______________________
_______ Out-patient (Specify) _____
b) NUMBER OF WORKING DAYS _______________________
APPLIED FOR: _____________ COMMUTATION:

INCLUSIVE DAYS: _____________ _____ requested _____not requested


______________________________
______________________________ _______________________
Signature of Applicant Emp. No.
DETAILS OF APPLICATION
7. (a) CERTIFICATION OF LEAVE CREDITS 7. (b) RECOMMENDATION
As of _________________________
_______ APPROVAL
Vacation Sick Total _______ DISAPPROVAL due to _____
_________________________
_________________________

NOEL F. FLORES
Head Teacher III
MERLE M. DE JESUS
Administrative Officer V
7. c) APPROVED FOR : 7. (d) DISAPPROVED
_________ Days with pay
_________ Days without pay
_________ Others (Specify)

MINA GRACIA L. ACOSTA, CESE


OIC-Assistant Schools Division Superintendent (Elem)
Authorized Official

You might also like