CSC Form 6 Revised 1984

SCHOOLS DIVISION OFFICE

City of Muntinlupa
ISO 9001:2008 Certified

APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First) (M.I.)

DepEd - SDO Muntinlupa

3. Date of Filing 4. Position 5. Salary (Monthly) 6. EMPLOYEE NO.

DETAILS OF APPLICATION
6. A) Type of leave 6. B) Where leave will be spent ?

Vacation In case of vacation leave

To seek employment Within the Philippines
Sick Abroad (Specify):
Maternity
Monetization
Others (Specify):
In Hospital (Specify) :

Out Patient (Specify) :

C) Number of working days 6. D) Commutation

applied for:
Requested
Inclusive Dates : Not requested

___________________________________
(Signature of Applicant)
7. A) Certification of leave 7. B) Recommendation
credits as of :
Approval
VACATION SICK TOTAL Disapproval due to :

MARIA CORAZON C. PALOMIQUE, Ed. D. _____________________________

Administrative Officer IV / HRMO Authorized Official

7. C) Approved for : 7. D) Disapproved due to:

_____________ days with pay _______________________________
_____________ days without pay _______________________________
_____________ others (specify) _______________________________

For and by the Authority of the Schools Division Superintendent

NOEL D. BAGANO
OIC - Asst. Schools Division Superintendent

1. An application of leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance
of money and property accountabilities.
2. Application for vacation leave or sick leave for one full day or more shall be made on this form and to be
accompanied in duplicate.
3. Application for leave shall be filed in advance or whenever possible five (5) days before going on such leave.
4. Application for sick leave filed in advance or exceeding five (5) days shall be accompanied with medical certificate.
5. An employee who is absent without approved leave should not be entitled to receive salary corresponding
to the period of his unauthorized leave of absence.
CSC Form 6 Revised 1984
SCHOOLS DIVISION OFFICE
City of Muntinlupa
ISO 9001:2008 Certified

APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First) (M.I.)

DepEd - SDO Muntinlupa

3. Date of Filing 4. Position 5. Salary (Monthly) 6. EMPLOYEE NO.

DETAILS OF APPLICATION
6. A) Type of leave 6. B) Where leave will be spent ?

Vacation In case of vacation leave

To seek employment Within the Philippines
Sick Abroad (Specify):
Maternity
Monetization
Others (Specify):
In Hospital (Specify) :

Out Patient (Specify) :

C) Number of working days 6. D) Commutation

applied for:
Requested
Inclusive Dates : Not requested

___________________________________
(Signature of Applicant)
7. A) Certification of leave 7. B) Recommendation
credits as of :
Approval
VACATION SICK TOTAL Disapproval due to :

MARIA CORAZON C. PALOMIQUE, Ed. D. NOEL D. BAGANO

Administrative Officer IV / HRMO Authorized Official

7. C) Approved for : 7. D) Disapproved due to:

_____________ days with pay _______________________________
_____________ days without pay _______________________________
_____________ others (specify) _______________________________

MAURO C. DE GULAN, Ed. D.

Schools Division Superintendent

1. An application of leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance
of money and property accountabilities.
2. Application for vacation leave or sick leave for one full day or more shall be made on this form and to be
accompanied in duplicate.
3. Application for leave shall be filed in advance or whenever possible five (5) days before going on such leave.
4. Application for sick leave filed in advance or exceeding five (5) days shall be accompanied with medical certificate.
5. An employee who is absent without approved leave should not be entitled to receive salary corresponding
to the period of his unauthorized leave of absence.