FOR TEACHERS & NON-TEACHING

PERSONNEL USE ONLY

(SECONDARY SCHOOLS)
MORE THAN 60 DAYS
 

  Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

CSC Form 6 Revised 1998

APPLICATION FOR LEAVE

1. Office/Agency 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 (Monetization)

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 Approval

Disapproval due to
days days days

School Head
Administrative Officer IV, Personnel

Assistant Schools Division Superintendent

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

Assistant Schools Division Superintendent

Officer-In-Charge
Office of the Schools Division Superintendent
Date: _________________
INSTRUCTION
1. Application for vacation or sick for one (1) full day or more shall be made on the accomplish at least in triplicate.
2. Application for vacation leave shall be in advance or whenever possible five (5) days before going on such leave.
3. Application for sick leaved filed in advance for more than five (5) days shall be accompanied by a medical certificate in case medical consultation
was not availed and an affidavit should be filed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding to the period of his unauthorized
leave of absence.
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance from money and property
accountabilities and for endorsement addressed and duly approved by the Schools Division Superintendent.

Address: Alvear St., East Capitol Grounds, Document Code: SDO1P-FR000

Lingayen, Pangasinan Revision No.: 01
Telephone No.:(075)-522-2202 Page No.: Page 1 of 1
Address: Alvear St., East Capitol Grounds, Document Code: SDO1P-FR000
Lingayen, Pangasinan Revision No.: 01
Telephone No.:(075)-522-2202 Page No.: Page 1 of 1
Email: pangasinan1@deped.gov.ph Effectivity Date: 11-23-2020