APPLICATION FOR LEAVE

CSC Form 6
Revised 1984
1. Office/Agency: 2. NAME (Last) (First) (Middle)

3. Date of Filing: 4. Position: 5. Salary (Monthly)

DETAILS OF APPLICATION
6. a) Type b) Where leave will be spent:
1. In case of Vacation Leave
Vacation
within the Philippines
Sick
Maternity Others (specify)

Force Leave 2. In case of Sick Leave

Others (specify) In-Hospital (specify)

c) Number of Working Days Applied Out-Patient (specify)

days d) Commutation:

Inclusive Dates Requested Not Requested

From

To
Signature of Applicant

DETAILS OF ACTION OF APPLICATION

7. a) Certification of Leave Credits b) RECOMMENDATION:
as of

Vacation Sick Total Approved

(No. of days) (No. of days) (No. of days)

Balance Disapproved

Used

Rem. Bal.

RENZ ROY A. RAMOS, HRMO II

(Authorized Official) (Authorized Official)

c) APPROVED FOR: d) DISAPPROVED DUE TO:

days with pay
days without pay
others (specify)

(Signature)

(Date) DR. JEANELYN A. ALEMAN, CESO VI

OIC Schools Division Superintendent
 (Authorized Official)

INSTRUCTION:
1) Application for vacation or sick leave for one full day or more shall be on this form.
2) Application for vacation leave shall be filed in advance or whenever possible, five(5) days before going on such leave.
3) Application for sick leave filed in advance or exceeding five (5) days shall be accompanied by a Medical Certificate
with documentary stamp issued by a Private Physician and their License Number should be clearly indicated.