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CSC Form6

This document is an application for study leave submitted by Raymond A. Gorda, a Secondary School Teacher III at Cawayan National High School who is detailed at Galutan National High School. He is requesting leave from April 4, 2016 to March 31, 2017 to pursue further studies. The application includes his personal details, position and salary information. It requires recommendations from his immediate head and the administrative officer on his leave credits and approval by the Schools Division Superintendent.

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Raymond Gorda
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979 views

CSC Form6

This document is an application for study leave submitted by Raymond A. Gorda, a Secondary School Teacher III at Cawayan National High School who is detailed at Galutan National High School. He is requesting leave from April 4, 2016 to March 31, 2017 to pursue further studies. The application includes his personal details, position and salary information. It requires recommendations from his immediate head and the administrative officer on his leave credits and approval by the Schools Division Superintendent.

Uploaded by

Raymond Gorda
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
Regional Office No. VIII (Eastern Visayas)
DIVISION OF NORTHERN SAMAR
Catarman, Northern Samar

CSC Form 6
(Revised 2015)

APPLICATION FOR LEAVE


1. Office/Agency
DepED Northern Samar
Cawayan National High School
(detailed at Galutan National High School)
2. Name:

GORDA,

RAYMOND

(Last Name)

(First Name)

3. Date of Filing:

May 2, 2016
6. a. Type of Leave
Vacation Leave
To seek employment
Forced Leave
Sick Leave
Maternity Leave
Others (Please specify)

Study Leave

Employee ID/Number:
0010819
(detailed
at
Galutan
National High School)
School/Office:
Catarman IV
District:
Employee Contact Number:
09093837760

ARNIO
(Middle Name)

4. Position:
5. Monthly Salary:

Secondary School Teacher III


Php 22,328.00

6.b. Where leave will be spent in case of Vacation Leave?

In case of Sick Leave, please specify the place of recovery.

Commutation
7.

Requested
Not Requested

Number of working days applied:


Inclusive dates: April 4, 2016 - March 31, 2017

RAYMOND A. GORDA
(Signature over Printed Name of Employee)

TERESITA C. MARINO
(Signature over Printed Name of Immediate Head)

7. A. Certification of Leave Credits


Vacation Leave
Credits

Sick Leave Credits

DETAILS OF ACTION ON APPLICATION


7. B. Recommendation
Total Leave
Credits

Vacation Leave
Credits

Administrative Officer

Sick Leave Credits

Total Leave
Credits

Administrative Officer

7. C. APPROVED FOR:

7. D. DISAPPROVED due to:

days with pay


days without pay

MANUEL P. ALBAO, CESO V


Schools Division Superintendent
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2. Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical

certificate.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period his authorized leave
of absence.

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