CSC Form No.

Revised 1964

APPLICATION FOR LEAVE

DepEd Rizal Region National High School GUZMAN JOHNLERY SACATROPEZ
1. OFFICE/ AGENCY 2. NAME (LAST) (FIRST) (MIDDLE)
Teacher II 22,938.00
1-Feb-20 4. POSITION 5. SALARY (MONTHLY)
3. DATE OF FILING

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
[ ] Death: _______________
[ ] Injury: _______________ (2) IN CASE OF SICK LEAVE
[ ] Sickness (Pls. specify) _______________
[ ] Maternity: ________________________ [ ] On Hospital (specify)
[ ] Others (specify)______________________
_______________________________ [ ] Out Patient (specify)

6. c.) NUMBERS OF WORKING DAYS APPLIED FOR 6.d.) COMMUTATION

[ / ] Requested [ ] Not Requested

INCLUSIVE DATES: ___________________

(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. a.) CERTIFICATION OF LEAVE/ CREDITS 7. b.) RECOMMENDATION

As of
Vacati
on Sick Total
Days Days Days

LORDINO G. ANTONIO
SEPS/OIC-PRINCIPAL

LOU JANE M. NICOLAS

Administrative Assistant IV

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

days with pay
days without pay
others (specify)

MADELYN L. MACALLING, PhD, CESO VI

Assistant Schools Division Superintendent / OIC - Schools Division Superintendent
CSC Form No. 6

Revised 1964

APPLICATION FOR LEAVE

DepEd Rizal Region National High School GUZMAN JOHNLERY SACATROPEZ
1. OFFICE/ AGENCY 2. NAME (LAST) (FIRST) (MIDDLE)
Teacher II 27,608.00
Sept. 19, 2022 4. POSITION 5. SALARY (MONTHLY)
3. DATE OF FILING

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
[ ] Death: _______________
[ ] Injury: _______________ (2) IN CASE OF SICK LEAVE
[ ] Sickness (Pls. specify) _______________
[ ] Maternity: ________________________ [ ] On Hospital (specify)
[ ] Others (specify)______________________
_______________________________ [ ] Out Patient (specify)

6. c.) NUMBERS OF WORKING DAYS APPLIED FOR 6.d.) COMMUTATION

[ / ] Requested [ ] Not Requested
One (1) day
INCLUSIVE DATES: September 20, 2022

(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. a.) CERTIFICATION OF LEAVE/ CREDITS 7. b.) RECOMMENDATION

As of
Vacati
on Sick Total
Days Days Days

JULIETA M. DOMINGO, EdD.

Principal IV

LOU JANE M. NICOLAS

Administrative Assistant IV

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

days with pay
days without pay
others (specify)

MADELYN L. MACALLING, PhD, CESO VI

Schools Division Superintendent