Republic of the Philippines

Department of Education
Region IV – A: CALABARZON
Division of Rizal

C.S.C. FORM NO. 6 APPLICATION FOR LEAVE

1. District/School 2. NAME (LAST) (FIRST) (MIDDLE)

Taytay I
Taytay Senior High School___________________________________________________________________
3. DATE OF FILING: 4. POSITION: 5. Monthly Salary:

DETAILS OF APPLICATION
6. A) TYPE OF LEAVE B) WHERE LEAVE WILL BE SPENT
Vacation In case of vacation leave

To seek employment Within the Philippines

Other (Specify) Abroad (Specify)

__________________________ _______________________
Sick In case of sick leave

Maternity In Hospital ( specify)

Other (Specify) Out Patient ( specify)

__________________________ ________________________
__________________________________________________________________________________________
6. C. NUMBER OF WORKING DAYS D. COMMUTATION
APPLIED FOR: __________________ Requested

Inclusive Dates: __________________ Not Requested

____________________________
Signature of Applicant
__________________________________________________________________________________________
7. A) CERTIFICATION ON LEAVE CREDITS B) RECOMMENDATION:

AS OF:-------------------------------------------
Vacation Sick Total Approved

Disapproved due to:

___________________________

AMELIA R. DEAN MAGNO R. ABUEME

Administrative Officer V Principal II

RECOMMENDATION:
Approved Disapproved
___________________________________
(Authorized Official)
________________________________________________________________
APPROVED FOR: DISAPPROVED DUE TO:
( ) days with pay ___________________________________
( ) days without pay ___________________________________
( ) others specify ___________________________________

JUAN R. ARAOJO JR.

OIC, Office of the Assistant Schools Division Superintendent