Republic of the Philippines

DEPARTMENT OF EDUCATION
C o rd i l l er a Ad m i n is t r a t iv e R e g io n
SCHOOLS DIVISION OF BENGUET
Wangal, La Trinidad, Benguet 2601
Office of the SDS: (074) 422-6570 (telefax); Administrative Office: (074) 422-3790; Accounting Office: (074) 422-7501;
Supply Office: (074) 424-2863; Lobby/Officer of the Day: (074) 422-2001

CSC Form 6
Revised 1984
APPLICATION FOR LEAVE
1. DISTRICT/SCHOOL/OFFICE 2. LAST NAME FIRST NAME MIDDLE NAME
LES-ENG ELEMENTARY SCHOOL ELMO MERCY BUYAGAN
3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)
FEBRUARY 5, 2020 TEACHER I 20, 754.00

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT
Vacation b.1. In case of Vacation Leave
To seek employment Within the Philippines
Others (specify) Abroad (specify)

Sick b.2. In case of Sick Leave

Maternity / Paternity In Hospital (specify)
Others (specify) Out Patient
--
6. c) NUMBER OF WORKING DAYS APPLIED FOR -- 6. d) COMMUTATION
APPLIED FOR Three days (3) Requested
INCLUSIVE DATES February 5 - 7, 2020 Not requested

Signature of Applicant
Employee Number 4858056
Date of Original Appointment July 06, 2016

DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
as of Approval
Disapproval due to:
Vacation Sick CTO/COC PL Others TOTAL
EARNED
SPENT
BALANCE
TONY L. TIBAO
(PSDS/School Head)
GLENN N. DUGUIS
Administrative Officer

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

day/s WITH pay
day/s WITHOUT pay
others (specify)

BENILDA M. DAYTACA, EdD, CESO VI

Assistant Schools Division Superintendent
OIC-Office of the Schools Division Superintendent

DATE:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
C o rd i l l er a Ad m i n is t r a t iv e R e g io n
SCHOOLS DIVISION OF BENGUET
Wangal, La Trinidad, Benguet 2601
Office of the SDS: (074) 422-6570 (telefax); Administrative Office: (074) 422-3790; Accounting Office: (074) 422-7501;
Supply Office: (074) 424-2863; Lobby/Officer of the Day: (074) 422-2001

CSC Form 6
Revised 1984
APPLICATION FOR LEAVE
1. DISTRICT/SCHOOL/OFFICE 2. LAST NAME FIRST NAME MIDDLE NAME

3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT
Vacation b.1. In case of Vacation Leave
To seek employment Within the Philippines
Others (specify) Abroad (specify)

Sick b.2. In case of Sick Leave

Maternity / Paternity In Hospital (specify)
Others (specify) Out Patient
--
6. c) NUMBER OF WORKING DAYS APPLIED FOR -- 6. d) COMMUTATION
APPLIED FOR Requested
INCLUSIVE DATES Not requested

Signature of Applicant
Employee Number
Date of Original Appointment

DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
as of Approval
Disapproval due to:
Vacation Sick CTO/COC PL Others TOTAL
EARNED
SPENT
BALANCE

(PSDS/School Head)
GLENN N. DUGUIS
Administrative Officer

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

day/s WITH pay
day/s WITHOUT pay
others (specify)

BENILDA M. DAYTACA, EdD

Assistant Schools Division Superintendent
OIC-Office of the Schools Division Superintendent

DATE: