CSC Form 6 SCHOOL HEAD, 5 DAYS OR MORE

DepEd Division of Gingoog City

APPLICATION FOR LEAVE
1. Office/Agency/School: 2. Name: (Last) (First) ( MI )

3. Date of Filing: 4. Position 5. Salary (monthly)

DETAILS FOR 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) _______________
(2) In case of Sick Leave
Sick In Hospital (specify)
Maternity Out-Patient (specify) ____________
Others (Specify) __________________ ________________________________

6. c) Number of working days applied for: 6. d) Commutation:

Requested Not Requested
Inclusive Dates:

Signature of Applicant
DETAILS OF ACTION OF APPLICATION

7. a) Certificate of Leave Credits: 7. b) Recommendation:

as of Disapproved due to : _________________
_____________________________________
Vacation Sick Total

GEMRO G. ROSIOLADO
days days days Administrative Officer V

JASPER C. BUNGALON
HR/Personnel Officer

7. c) Approved for: 7. d) Recommendation:

days with pay Approved
days without pay Disapproved due to ___________
others (specify) ______________________________
Date: _________

OLGA C. ALONSABE, Ph. D.

OIC-Schools Division Superintendent
1. Application for vacation/sick leave for one or more shall be made on this form and to be accomplished at
least in duplicate.
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going such
leave.
3. Application for sick leave filed in advance or exceeding five (5) days shall be accomplished accompanied by
Medical Certificate, in case Medical Certificate is not availed, an affidavit of absence shall be executed.