CSC Form 6

Revised 1998

APPLICATION FOR LEAVE

1. Office/School/District 2. Name (Last) (First) (Middle)

3. Date of Filling 4. Position 5. Salary

P
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)

Sick 2. In case of sick Leave (Please tick one)

Maternity In hospital (Specify)

Other (Specify)

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

Requested 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 Approved

Balance before
deduction Disapproval due to

Deduction

Balance after
deduction

EPPIE P. CABRERA, AO-IV

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

JOSITA B. CARMEN, CESO V

Schools Division Superintendent
Date: _________________
1. Application for vacation/sick leave for one day or more shall be made on the form and to be accomplished at least in duplicate.

2. Application for vacation leave shall be filed in advance or whenever possible 5 days before going such leave.