CSC Form No.

6
Revised 2002

1. OFFICE/AGENCY 2. NAME: (Last) (First) (Middle)

DIVISION OR CITY SCHOOL
Placer District I________ CATAMORA, MARGARETE JANE MIOLE
Badas Elementary School
3. DATE OF FILING 4.POSITION: 5. SALARY (Monthly)
June 01, 2021 Teacher I ₱24,450.00
DETAILS FOR 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) ____________ Out patient (specify) __________
c. NUMBER OF WORKING DAYS APPLIED FOR: d) COMMUTATION
___________ _105 DAYS_______________ Requested Not Requested
INCLUSIVE DATES:
___June 07, 2021 to September 19, 2021__ ________________________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATE OF LEAVE CREDITS 7. b) RECOMMENDATION
As of _________________________ Approval
Disapproval due to
VACATION SICK TOTAL _____________

Days Days Days

___________________________ ALICIA N. MAINIT, EdD

(Personnel Officer) (Authorized Official)

7. c. APPROVED FOR: 7. d) RECOMMENDATION

___________ days with pay Approval
___________ days without pay Disapproval due to __________
___________ others (specify) ____________________

________________________________________
(Signature)

MA. TERESA M. REAL

(Authorized Official)

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 wherever possible 5 days before going such leave.
3. Application for sick leave filed in advance or exceeding five days (5) days shall be accomplished accompanied by medical
certificate. In case medical certificate is not availed of, an affidavit of absence shall be executed.