Form 6 (Application For Leave)

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CSC Form 6

APPLICATION FOR LEAVE


__________________________________________________________________________________________
1. Office/Agency 2. Name (Last) (First) (Middle)
DepEd ISANAN CATHERINE PAGAYON
__________________________________________________________________________________________________
3. Date of Filing 4. Position 5. Salary (Monthly)
JANUARY 17, 2020 TEACHER I 23,038.00
__________________________________________________________________________________________________

DETAILS OF APPLICATION
6.a. Type of Leave 6.b. Where will be presented
1. In case of vacation leave
Vacation With in the Philippines __________________
To seek employment Abroad (Specify) __________________
/
Sick 2. In case of Sick Leave
Maternity In Hospital (Specify) __________________
Others (Specify) __________________________ / Outpatient (Specify) _ _ _______________

6. c. Number of working days applied for 1 Day COMMUTATION:


Inclusive Dates from JANUARY 17, 2020 to JANUARY 17, 2020
/
Requested Not Requested

________ ________________
Signature of Applicant

____________________________________________________________________________________________________________ _____

DETAILS OF ACTION ON APPLICATION


7.a. Certification of Leave Credits as of: _____________________ 7.b. Recommendation
Vacation Sick Total
Approval
Disapproval Due to ________________________________
_____ days _____ days _____ days ________________________________

_____________________________
School Head/Administrator

RENE P. RAMOS
Administrative Officer V
_________________________________________________________________________________________________
7.c. APPROVED for: 8.b. DISAPPROVED DUE TO:
______ day/s V/L S/L M/L with pay ____________________________________________
______ day/s V/L S/L M/L without pay ____________________________________________
______ day/s Others (specify) ____________________________________________

APPROVED:

Engr. JESSE M. GOMEZ, PhD, CESO V


Schools Division Superintendent

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