CSC Form No.

6
Revised 1984

Republic of the Philippines

Department of Education
Region VII, Central Visayas
DIVISION OF MANDAUE CITY
Mandaue City

APPLICATION FOR LEAVE

Employee No.

1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

DEPED MILLOR CHRISTINE C.
3. DATE OF FILING 4. POSITION 5. SALARY(MONTHLY)
FEB. 6, 2019 TEACHER 1 20, 179
DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT

Vacation In case of Vacation Leave
To seek employment Within the Philippines
Others (specify) Abroad (specify)

Sick In case of Sick Leave

Maternity --In Hospital (specify)
Others (specify) --Out Patient (specify)

6. c). NUMBER OF DAYS APPLIED FOR: 6. d). COMMUTATION

Working Days
Inclusive Dates: Requested Not Requested

Signature of Applicant

7. a). CERTIFICATION OF LEAVE CREDITS 7. b). RECOMMENDATION

as of _______________________________
____________________________________ Approved

Vacation Sick Total Disapproval due to ___________________________

_____________________________________________

Vacation Sick Total FERNANDO V. YLAYA, MAEd.

Principal

EDGAR C. ESPINA JR., MAEd. JOCELYN G. VILLAMOR, MA - ELT.

Administrative Officer PSDS

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

days w/ pay _____________________________________________
days w/o pay _____________________________________________
others (specify)

Signature

LEAH P. NOVERAS, Ed.D.,CESO VI

Schools Division Superintendent

INSTRUCTIONS
1. Application for vacation or sick leave for one full day or more shall be made on this Form and to be accomplished at least in duplication.
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 shall be filed in advance , or exceeding five (5) days shall be accompanied by a medical certificate. In case medical consultation was not
availed of an affidavit should be executed by applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding to the period of his/her authorized leave of absence.
5. An application for leave of absence of thirty (30) calendar days or more shall be accompanied by a clearance from money and property.
 Employee No. Employee No.
Civil Service Form No. 48 Civil Service Form No. 48 Civil Service Form No. 48
DAILY TIME RECORD DAILY TIME RECORD
CHRISTINE C. MILLOR CHRISTINE C. MILLOR CHR
(Name) (Name)

For the month of Jan-19 For the month of Jan-19 For the month of
Official hours of arrival Regular days7:30-12:00 1:00-4:30 Official hours of arrival Regular days 7:30-12:00 1:00-4:30 Official hours of arrival
and departure Saturdays: IF NEEDED and departure Saturdays: IF NEEDED and departure

A.M. P.M. Undertime A.M. P.M. Undertime A.M.

Day Day Depar- Depar- Day
Arrival Depar-ture Arrival Depar-ture Hours Minutes Arrival ture Arrival ture Hours Minutes Arrival
1 1 1
2 2 2
3 7:25 12:00 12:01 17:15 3 7:25 12:00 12:01 17:15 3 7:25
4 4 4
5 5 5
6 6 6
7 7 7
8 7:25 12:02 12:05 16:59 8 7:25 12:02 12:05 16:59 8 7:25
9 7:21 12:12 12:13 16:57 9 7:21 12:12 12:13 16:57 9 7:21
10 7:28 12:45 12:46 17:28 10 7:28 12:45 12:46 17:28 10 7:28
11 7:29 12:26 12:27 17:25 11 7:29 12:26 12:27 17:25 11 7:29
12 12 12
13 13 ` 13
14 7:32 12:10 12:12 23:13 14 7:32 12:10 12:12 23:13 14 7:32
15 7:25 12:00 12:02 21:51 15 7:25 12:00 12:02 21:51 15 7:25
16 7:28 12:47 12:49 18:51 16 7:28 12:47 12:49 18:51 16 7:28
17 7:35 12:47 12:49 19:35 17 7:35 12:47 12:49 19:35 17 7:35
18 7:20 12:48 12:49 18:36 18 7:20 12:48 12:49 18:36 18 7:20
19 19 19
20 20 20
21 7:14 12:31 12:34 18:36 21 7:14 12:31 12:34 18:36 21 7:14
22 7:12 12:50 12:52 18:35 22 7:12 12:50 12:52 18:35 22 7:12
23 7:15 12:41 12:43 16:34 23 7:15 12:41 12:43 16:34 23 7:15
24 7:17 12:51 12:52 17:49 24 7:17 12:51 12:52 17:49 24 7:17
 25 7:10 12:17 12:19 16:52 25 7:10 12:17 12:19 16:52 25 7:10
26 7:30 12:10 12:15 16:30 26 7:30 12:10 12:15 16:30 26 7:30
27 27 27
28 7:21 12:40 12:41 17:37 28 7:21 12:40 12:41 17:37 28 7:21
29 7:35 12:33 12:36 16:35 29 7:35 12:33 12:36 16:35 29 7:35
30 7:28 12:35 12:36 16:41 30 7:28 12:35 12:36 16:41 30 7:28
31 7:22 12:33 12:34 17:12 31 7:22 12:33 12:34 17:12 31 7:22
Total: 29 DAYS, with 12 minutes late Total: 29 DAYS, with 12 minutes late Total: 29 DAYS, with 12 m

I certify on my honor that the above is true and correct report of the I certify on my honor that the above is true and correct report of the I certify on my honor that the above is t
hours of work performed, record of which was made daily at the time hours of work performed, record of which was made daily at the time hours of work performed, record of whi
of arrival and departure from office. of arrival and departure from office. of arrival and departure from office.

VERIFIED as to the prescribed office hours: VERIFIED as to the prescribed office hours: VERIFIED as to the prescribe

FERNANDO V. YLAYA, MAEd. FERNANDO V. YLAYA, MAEd. FERN

In Charge In Charge
 Employee No.
m No. 48
DAILY TIME RECORD
CHRISTINE C. MILLOR
(Name)

Jan-19
arrival Regular days 7:30-12:00 1:00-4:30
Saturdays: IF NEEDED

A.M. P.M. Undertime

Depar- Depar-
ture Arrival ture Hours Minutes

12:00 12:01 17:15

12:02 12:05 16:59

12:12 12:13 16:57
12:45 12:46 17:28
12:26 12:27 17:25

12:10 12:12 23:13

12:00 12:02 21:51
12:47 12:49 18:51
12:47 12:49 19:35
12:48 12:49 18:36

12:31 12:34 18:36

12:50 12:52 18:35
12:41 12:43 16:34
12:51 12:52 17:49
 12:17 12:19 16:52
12:10 12:15 16:30

12:40 12:41 17:37

12:33 12:36 16:35
12:35 12:36 16:41
12:33 12:34 17:12
YS, with 12 minutes late

hat the above is true and correct report of the

ed, record of which was made daily at the time
e from office.

he prescribed office hours:

FERNANDO V. YLAYA,MAEd.
In Charge