Republic of the PhilippinesDepartment of Education

Region X Northern Mindanao

DIVISION OF OZAMIZ CITY

City of Ozamiz

Telephone/Fax No. (088) 521-2878 / 521-3317 / 521-1105

CS FORM 6Revised 1984

APPLICATION FOR LEAVE

1. OFFICE / AGENCY:2. NAME: (Last Name) (First Name) (Middle Name)

3. Date:

4. Position:

5. a. Basic Salary:

5. b. TIN:

6. DETAILS OF APPLICATION

6. a. TYPE OF LEAVE

VACATION To seek employment

Others (Specify) SICK LEAVE

Maternity

Others (Specify)

6. b. WHERE LEAVE BE SPENT IN CASE OF VACATION LEAVE With in the Philippines Abroad (Specify)

IN CASE OF SICK LEAVE In hospital (Specify)

Outpatient (Specify)

6. c. NUMBER OF WORKING DAYS APPLIED

FOR:

Inclusive Dates: 6. d. COMMUTATION REQUESTED NOT REQUESTED

Signature of Applicant

7. DETAILS OF ACTION ON APPLICATION

7. a. CERTIFICATION OF LEAVE CREDITSVacation

SickTotalDay/sDay/sDay/s As of

NENITH B. MEHOY Administrative Officer V7. b. RECOMMENDATION Approval

Disapproval due to

PSDS / School Principal / Head Teacher / TIC

7. c. APPROVED FOR day/s with pay

day/s without pay

other (specify)

Date: 7. d. APPROVED DISAPPROVEDREBONFAMIL R. BAGUIO

Assistant Schools Division Superintendent

OIC, Schools Division Superintendent

INSTRUCTIONS:1. Application for vacation or sick leave for one full day or more shall be made to be accomplished at least in duplicate.2. Application for vacation leave shall be filed in advance or whatever possible five (5) days such leave.3. Application for sick leave filed in advance or exceeding five (5) days shall be accomplished by medical certification in case in medical consultation was not valid of, an affidavit should be executed by the applicant.4. An employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding to the unauthorized leave of absent.5. An application for leave of absence for thirty (30) days or more shall be accompanied by a clearance from money and property accountabilities.1

2