APPLICATION FOR LEAVE CSC FORM 6 Revised 1984 1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle) 3. Date of Filing 4, Position . Salary (Monthly) DETAILS OF APPLICATION 6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT 11 Vacation (1) IN CASE OF VACATION To seek employment 7 within the Philippines (Others (Specify) 1 FAbroad (Specify) 11 Sick (2) INCASE OF SICK LEAVE 11 Maternity 7 [ln hospital (Specity) 1 Others (Specify) Jf Outpatient (Specify) ‘¢) NUMBER OF WORKING DAYS APPLIED FOR 4) COMMUTATION JF Requested 1 INot Requested INCLUSIVE DATES Signature of Applicant DETAILS OF ACTION ON APPLICATION 7. a) CERTIFICATION OF LEAVE CREDITS: b) RECOMMENDATION as of 1 [Approved | / Disapproved due to Vacation Sick ‘Total Administrative/Personnel Officer District Supervisor/Principal ¢) RECOMMENDATION 1 Approved 1 1 Disapproved ‘Schools Division Superintendent d) APPROVED FOR ‘e) DISAPPROVED DUE TO days with pay days without pay others (Specify) ignature (Authorized Official) NOTE: 41. Application for vacation leave or sick leave for one full day or more shall be rade on this form to be accomplished at least in duplicate. 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 days shall be accompanied by a medical certificate. in case of medical certiicate was not availed or an affidavit should be executed by the applicanr. 4, An-employee who is absent without approved leave shall not be entitled to reosive his salary corresponding to the period of his unauthorized leave of absence. 5. An application for leave of absence of thirty (30) calendar days or more shalll be accompanied by a clearanos from money and property accountabiltyCLEARANCE Date TO WHOM IT MAY CONCERN: This is to certify that the undersigned is cleared of money and property accountabilities. Her/his last day of service in our school is : Issued upon request of the interested party for purpose or purposes it may serve.