CSC Form 6 Use this form for Senior High School

Revised 1998

APPLICATION FOR LEAVE

1. School (SHS) 2. Name (Last) (First) (Middle)

3. Date of Filing 4. Position 5. Salary

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

Maternity In hospital (Specify)
Others (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
Approval
Vacation Sick Total Disapproval due to

days days days

DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

Rowena T. Quiambao, CESE

OIC- Asst. Schools Division Supt. (Secondary)
Date: _________________
CSC Form 6
Revised 1998

APPLICATION FOR LEAVE

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

3. Date of Filing 4. Position 5. Salary

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

Maternity In hospital (Specify)
Others (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
Approval
Vacation Sick Total Disapproval due to

days days days

DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

Rowena T. Quiambao, CESE

OIC- Asst. Schools Division Supt. (Secondary)
Date: _________________
CSC Form 6
Revised 1998

APPLICATION FOR LEAVE

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

3. Date of Filing 4. Position 5. Salary

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

Maternity In hospital (Specify)
Others (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
Approval
Vacation Sick Total Disapproval due to

days days days

DEXTER E. PANGILINAN
Administrative Officer - IV School Head / Immediate Supervisor
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

LEONARDO C. CANLAS,Ed.,D.CESE
OIC-Asst. Schools Division Superintendent
Date: _________________
CSC Form 6 Use this form for Travel Abroad Only
Revised 1998

APPLICATION FOR LEAVE

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

3. Date of Filing 4. Position 5. Salary

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

Maternity In hospital (Specify)
Others (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
Approval
Vacation Sick Total Disapproval due to

days days days

DEXTER E. PANGILINAN Leonardo D. Zapanta, Ed.D. CESO VI

Administrative Officer - IV OIC- Schools Division Supt.
7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

Nicolas T. Capulong, Ph.D., CESO VI

Asst. Regional Director, OIC
Date: _________________
CSC Form 6
Revised 1998

APPLICATION FOR LEAVE

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

3. Date of Filing 4. Position 5. Salary

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

Maternity In hospital (Specify)
Others (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
Approval
Vacation Sick Total Disapproval due to

days days days

DEXTER E. PANGILINAN

Administrative Officer - IV School Head / Immediate Supervisor

7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

ZENIA G. MOSTOLES.Ed.D.,CESO V
 Schools Division Superintendent
Date: _________________