Republic of the Philippines

Department of Education
Region xi – Davao Region
Schools Division of Davao Oriental

CS Form No. 6 (Revised 1995) APPLICATION FOR LEAVE

CSC FORM 1:

Name : ( ) VACATION
( ) SPECIAL
Signature : ( ) Within the Philippines
( ) Abroad (Specify) d
Position :
( ) SICK LEAVE
Monthly Salary : ( ) Out Patieny
( ) In Hospital (Specify) d
Office/ Division :

Date of Filing : ( ) Others (Specify)

No. of Working
: ACTION ON APPLICATION
Days Applied For

Inclusive Dates : Recommending

: ( ) Approval
: ( ) Dissapproval due to d
Commutation: :
:
( ) Requested ( ) Not Requested :
: School Head
FOR PERSONNEL USE ONLY: :
:
V.L. S.L. TOTAL :
:
Leave Credits D ( ) APPROVED FOR: ( ) DISAPPROVED due to
As of d d D :
:

Less: This Leave D :

Days w/pay
Balance D : Days w/o pay
:
:
Certified By: : Approved:
:
EMMA O. RABUYA : MARIA GENEVIEVE T. FRANCISQUETE, Ed. D.
Administrative Officer V : Assistant Schools Division Superintendent

Date:

“GOVERNANCE THROUGH EXCELLENCE WITH INTEGRITY ANYTIME, ANYWHERE”

Address: Government Center, Dahican, Mati City, Davao Oriental ISO 9001:2015
Telephone Number: (087) 388-3372 CERTIFIED
 Republic of the Philippines
Department of Education
Region xi – Davao Region
Schools Division of Davao Oriental

CS Form No. 6 (Revised 1995) APPLICATION FOR LEAVE

CSC FORM 1:

Name : ( ) VACATION
( ) SPECIAL
Signature : ( ) Within the Philippines
( ) Abroad (Specify) d
Position :
( ) SICK LEAVE
Monthly Salary : ( ) Out Patieny
( ) In Hospital (Specify) d
Office/ Division :

Date of Filing : ( ) Others (Specify)

No. of Working
: ACTION ON APPLICATION
Days Applied For

Inclusive Dates : Recommending

: ( ) Approval
: ( ) Dissapproval due to d
Commutation: :
:
( ) Requested ( ) Not Requested :
: School Head
FOR PERSONNEL USE ONLY: :
: MARIA GENEVIEVE T. FRANCISQUETE, Ed. D.
V.L. S.L. TOTAL : Assistant Schools Division Superintendent
:
Leave Credits D
As of d d D ( ) APPROVED FOR: ( ) DISAPPROVED due to
:

Less: This Leave D :

Days w/pay
Balance D : Days w/o pay
:
:
Certified By: : Approved:
:
EMMA O. RABUYA : REYNALDO B. MELLORIDA, CESO V
Administrative Officer V : Schools Division Superintendent

Date:

“GOVERNANCE THROUGH EXCELLENCE WITH INTEGRITY ANYTIME, ANYWHERE”

Address: Government Center, Dahican, Mati City, Davao Oriental ISO 9001:2015
Telephone Number: (087) 388-3372 CERTIFIED
 Republic of the Philippines
Department of Education
Region xi – Davao Region
Schools Division of Davao Oriental

CS Form No. 6 (Revised 1995) APPLICATION FOR LEAVE

CSC FORM 1:

Name : ( ) VACATION
( ) SPECIAL
Signature : ( ) Within the Philippines
( ) Abroad (Specify) d
Position :
( ) SICK LEAVE
Monthly Salary : ( ) Out Patieny
( ) In Hospital (Specify) d
Office/ Division :

Date of Filing : ( ) Others (Specify)

No. of Working
: ACTION ON APPLICATION
Days Applied For

Inclusive Dates : Recommending

: ( ) Approval
: ( ) Dissapproval due to d
Commutation: :
:
( ) Requested ( ) Not Requested :
: MARIA GENEVIEVE T. FRANCISQUETE, Ed. D.
FOR PERSONNEL USE ONLY: : Assistant Schools Division Superintendent
:
V.L. S.L. TOTAL :
:
Leave Credits D ( ) APPROVED FOR: ( ) DISAPPROVED due to
As of d d D
:

Less: This Leave D :

Days w/pay
Balance D : Days w/o pay
:
:
Certified By: : Approved:
:
EMMA O. RABUYA : REYNALDO B. MELLORIDA, CESO V
Administrative Officer V : Schools Division Superintendent

Date:

“GOVERNANCE THROUGH EXCELLENCE WITH INTEGRITY ANYTIME, ANYWHERE”

Address: Government Center, Dahican, Mati City, Davao Oriental ISO 9001:2015
Telephone Number: (087) 388-3372 CERTIFIED