FOR TEACHING (T1 – MT)

CSC Form 6
Revised 1984

APPLICATION FOR LEAVE (SCHOOL FORM)

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

3. DATE OF FILING 4. POSITION/EMPLOYEE NO. 5. MONTHLY 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)_______________
__________________________ _____________________________ Fill-up
[ ] Sick IN CASE OF SICK LEAVE according
[ ] Maternity [ ] In hospital (specify) ____________ to the
[ ] Others (specify) __________________ _____________________________ document
_______________________________ [ ] Out patient (specify) ___________ attached
(ex.
_____________________________ medical
6. c) NUMBER OF WORKING DAY/S APPLIED (2) COMMUTATION certificate)
[ ] Requested [ ] Not Requested
For __________________________day/s)

Inclusive Dates ________________________ ______________________________

(Signature of Applicant)
___________________________________

DETAILS ON ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of ______________________________ [ ] Approval
[ ] Disapproval due to _______________
Vacation Sick Total _______________________________

Days Days Days

_________________________
School Head

MAGDALENA A. LUCILLO
Administrative Officer IV – HRMO
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:

____________ day/s with pay _________________________________

____________ day/s without pay _________________________________
____________ others (specify)
Approved:

LEONARDO C. CANLAS EdD, CESO VI

Assistant Schools Division Superintendent
Date: _______________

Note: Use this form for leave of absence of Teacher I – III and Master Teacher I – II for up to 60 calendar days.
FOR TEACHING (T1 – MT)
CSC Form 6
Revised 1984

APPLICATION FOR LEAVE (SCHOOL FORM)

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

3. DATE OF FILING 4. POSITION/EMPLOYEE NO. 5. MONTHLY SALARY

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE: 6. b) WHERE LEAVE WILL BE SPENT:
[ ] Vacation (1) IN CASE OF VACATION LEAVE
Fill-up
[ ] To seek employment [ ] Within the Philippines according
[ ] Others (specify ______________ [ ] Abroad (specify)_______________ to the
__________________________ _____________________________ document
[ ] Sick IN CASE OF SICK LEAVE attached
[ ] Maternity [ ] In hospital (specify) ____________ (ex.
[ ] Others (specify) __________________ _____________________________ medical
_______________________________ [ ] Out patient (specify) ___________ certificate)
_____________________________
6. c) NUMBER OF WORKING DAY/S APPLIED (2) COMMUTATION
[ ] Requested [ ] Not Requested
For __________________________day/s)

Inclusive Dates ________________________ ______________________________

(Signature of Applicant)
___________________________________

DETAILS ON ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of ______________________________ [ ] Approval
[ ] Disapproval due to _______________
Vacation Sick Total _______________________________

Days Days Days

____________________________
School Head

MAGDALENA A. LUCILLO LEONARDO C. CANLAS EdD, CESO VI

Administrative Officer IV – HRMO Assistant Schools Division Superintendent

7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:

____________ day/s with pay _________________________________

____________ day/s without pay _________________________________
____________ others (specify)
Approved:

NORMA P. ESTEBAN EdD, CESO V

Schools Division Superintendent
Date: _______________
Note: Use this form for leave of absence of Teacher I – III and Master Teacher I – II for more than 60 calendar
days to one (1) year.