Form-6-leave-form.xls
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APPLICATION FOR LEAVE CSC Form No. 6 1. OFFICE/AGENCY
2. Name(Last)
DEPED MALVAR 3. DATE OF FILING
GANGGANGAN 4.
6.
6.a) Type of leave / / Vacation / / Sick / / Personal / / Maternity / / Study / / Others (Specify)
(First)
(Middle)
ARAÑO
WHILMA
POSITION
5. SALARY (Monthly)
23,257.00 Teacher III DETAILS OF APPLICATION 6.b) WHERE LEAVE WILL BE SPENT: 1. IN CASE OF VACATION LEAVE / / Within the Philippines / / Abroad(Specify) ……………………… ……………………………. 2. IN CASE OF SICK LEAVE / / In Hospital (Specify) ………………… ………………………………………… / / Out Patient (Specify) ……………….
6.c) NUMBER OF WORKING DAYS APPLIED FOR
6.d) COMMUTATION / / Requested / / Not Requested
INCLUSIVE DATES
(Signature of Applicant) DETAILS OF ACTION ON APPLICATION 7. 7. A) CERTIFICATION OF LEAVE CREDITS 7.b) RECOMMENDATION as of ………………………………………… Vacation
Sick
Total
Days
Days
Days
/ / Approval / / Disapproved due to …………………………..
RENATO M. ACERO Human Resource Management Officer Personnel Officer 7.c) APPROVED FOR:
… ….0 ..
LERMA C. RECIO Teacher In Charge 7. D) DISAPPROVED DUE TO
days with pay
…………… days without pay …………. others (Specify)
………………………………………………….. …………………………………………………..
CARLITO D. ROCAFORT, CESO V Schools Division Superintendent (Authorized Official) DATE ……………………………..
2. Name(Last)
DEPED MALVAR 3. DATE OF FILING
GANGGANGAN 4.
6.
6.a) Type of leave / / Vacation / / Sick / / Personal / / Maternity / / Study / / Others (Specify)
(First)
(Middle)
ARAÑO
WHILMA
POSITION
5. SALARY (Monthly)
23,257.00 Teacher III DETAILS OF APPLICATION 6.b) WHERE LEAVE WILL BE SPENT: 1. IN CASE OF VACATION LEAVE / / Within the Philippines / / Abroad(Specify) ……………………… ……………………………. 2. IN CASE OF SICK LEAVE / / In Hospital (Specify) ………………… ………………………………………… / / Out Patient (Specify) ……………….
6.c) NUMBER OF WORKING DAYS APPLIED FOR
6.d) COMMUTATION / / Requested / / Not Requested
INCLUSIVE DATES
(Signature of Applicant) DETAILS OF ACTION ON APPLICATION 7. 7. A) CERTIFICATION OF LEAVE CREDITS 7.b) RECOMMENDATION as of ………………………………………… Vacation
Sick
Total
Days
Days
Days
/ / Approval / / Disapproved due to …………………………..
RENATO M. ACERO Human Resource Management Officer Personnel Officer 7.c) APPROVED FOR:
… ….0 ..
LERMA C. RECIO Teacher In Charge 7. D) DISAPPROVED DUE TO
days with pay
…………… days without pay …………. others (Specify)
………………………………………………….. …………………………………………………..
CARLITO D. ROCAFORT, CESO V Schools Division Superintendent (Authorized Official) DATE ……………………………..
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