Csc_form_6_(leave_form-new).xlsx

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  • November 2019
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CSC Form 6 Revised 1998

APPLICATION FOR LEAVE 1. Office/Agency STO. TOMAS NHS 3. Date of Filing MARCH 5, 2019

2. Name (Last) GRACIAS 4. Position MASTER TEACHER I

(First) (Middle) MICHAEL STEPHERAMOS 5. Salary

DETAILS OF APPLICATION 6. A) Type of Leave Vacation To seek employment Others (Specify)

6. B) Where Leave will be spent: 1. In case of Vacation Leave Within the Philippines Abroad (Specify)

Sick Maternity Others (Specify)

2. In case of Sick Leave In hospital (Specify)

6. C) Number of Working Days applied for: 6. D) Commutation Requeste Inclusive Dates

Not Requested

Signature of Applicant

DETAILS OF ACTION ON APPLICATION 7. A) Certification of Leave Credits as of Vacation

Sick

Total

days

days

days

Authorized Official 7. C) Approved for: days with pay days without pay

7. B) Recommendation:

Approval Disapproval due to

Authorized Official 7. D) Disapproved due to:

Signature

Authorized Official

Date: _________________

Requested

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