CS Form 6

Revised 1984

1. OFFICE/AGENCY

APPLICATION FOR LEAVE

2. NAME:
(Last)

3. DATE OF FILING

6. a) TYPE OF LEAVE

4. POSITION

(First)

(Middle)

5. SALARY

(Monthly)

DETAILS OF APPLICATION
6. b) WHERE LEAVE BE SPENT:

______Vacation

(1.) IN CASE OF VACATION LEAVE

______To seek employment

______Others (Specify)

______Within the Philippines

______Abroad (Specify)

______Sick
______Maternity
______Others (Specify) _________

(2.) IN CASE OF SICK LEAVE________

______Hospital (Specify) ________
______Out Patient (Specify) ______

6. c) NUMBER OF DAYS
APPLIED FOR ________________
INCLUSIVE DATES ______________

6. d) COMMUTATION
______Requested
______Not Requested

____________________________________
(Signature of Applicant)
Employee No. _______________________
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
AS OF ________________________________
______Approval
______Disapproval due to ________
Vacation:
Sick:
Total:
________________________
________
________
________
________________________
________________________
Administrative Officer
7. c) APPROVED FOR:
________ days with pay
______________________________
________ days without pay
______________________________
________ others (Specify)

Principal

7. d) DISAPPROVED DUE TO:________

Date ___________
____________________________
Schools Division Superintendent
1.

Application for vacation or sick leave for one full day or more shall be made on the Form and to be accomplished in
duplicate.

2.

Application for vacation leave shall be filed in advance or whenever possible five (5) days before going on such leave.

3.

Application for sick leave filed in advance or exceeding five (5) days shall be accompanied by a medical certificate. In
case medical consultation were not availed 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 salary corresponding the period
of his unauthorized leave of absence.

5.

An application for leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance from
money