CSC Form 6

CSC Form No. 6

Revised 1988

                        APPLICATION FOR LEAVE

1.  OFFICE/AGENCY      DIVISION OF                                                          DISTRICT of                                                                                                                 SCHOOL		2.   NAME                           Employee No.:                        Last Name First Name Middle Name
3.  DATE OF FILING	4.  POSITION			5.  SALARY (Monthly)
DETAILS FOR APPLICATION
6. a)  TYPE OF LEAVE                               SICK LEAVE  (SL)                   Maternity Leave (ML)                   Others (specify)                               ü _                                                                      c) NUMBER OF WORKING DAYS APPLIED FOR:                                    INCLUSIVE DATES:			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) _______________________ ________________________________________ d)  COMMUTATION ü                     Requested                              Not Requested                                              Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7.  a)  CERTIFICATE OF LEAVE CREDITS          as of ____________________________ VACATION SICK TOTAL      Days Days Days __________________________ Personnel Officer			7.  b)  RECOMMENDATION                  Approval                  Disapproval due to ____________________                  ____________________________________                                                School Head

7.c) APPROVED FOR:                                               7 d)  RECOMMENDATION

                        days with pay                                                   Approval

                          days without pay                                             Disapproval due to ________________________

                         others (specify)                                                                        _________________________________

____________________________

(Signature)

____                                                                

Schools Division Superintendent

 (Authorized Official)

DATE:  ________________________

1. Application for vacation / sick leave for one day or more shall be made on the form and to be accomplished at least in duplicate.
2. Application for vacation leave shall be filed in advance or whenever possible 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 of, an affidavit of absence shall be executed.