Leave Application
Leave Application
CSC Form No 6
Revised 1984
OFFICE/AGENCY
Name
(Last)
(Date of Filling)
(First)
POSITION
(Middle)
SALARY (MONTHLY)
DETAILS OF APPLICATION
Sick Leave
Maternity Leave
Other (Specify) ____________________
____________________________________
c.) Number of Working Days applied for:
Signature of Applicant
DETAILS OF APPLICATION
a.) Certification of Leave Credits
c.) Recommendation
As of ______________________________
____________________________________
Vacation
Days
Sick
Days
Approval
Disapproval due to _____________
Total
Days
____________________________________
Personal Officer
b.) Approved for:
__________ days with pay
__________ days without pay
__________other Specify
Noted by:
NATIVIDAD S. ALEJANDRO
Teacher-in-Charge
Approved:
By Authority of Schools
Division Superintendent
NYMPHIA GUEMO
Assistant Schools Division Superintendent
Authorized Official
d.) Disapproval due to ______________________
_________________________________________
_________________________________________