CS Form 6 Revised 1984

APPLICATION FOR LEAVE

1.OFFICE/AGENCY 2. NAME: (last) (First) (M.I.)
DepEd-Antipolo NHS ROMERO SHIRLEY S.
3.Date of Filling 4. Position 5.Salary (Month)
June 19, 2017 Teacher III
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE: 6.b) WHERE LEAVE WILL BE SPENT:
- VACATION LEAVE
- SICK LEAVE 1. IN CASE OF VACATION LEAVE:
- Others (specify)______________________
- Within the Philippines
Non- Teaching Only - Abroad (specify) __________________
 Mandatory Force Leave (MFL) _______________________________
 Privilege/Special Leave (SPL)
 Compensatory Time Off (CTO) 2. IN CASE OF SICK LEAVE:
 Monetization/Commutation Leave - In Hospital (Specify)_______________
Teaching & Non- Teaching Only _______________________________
 Magnacarta for Women Leave * Paternity Leave
 Rehabilitation Leave * Study Leave - Out- Patient (Specify) _____________
 Sol Parent Leave (SP) * Maternity Leave ______________________________
 Violence Against Women Leave * Terminal Leave
6.d. COMMUTATION:
6.c) NUMBER OF WORKING DAYS APPLIED FOR: Requested
1
Not Requested
INCLUSIVE DATES: February, 15, 2017

______________________________
Signature of Employee

DETAILS OF ACTION IN APPLICATION

7. a) CERTIFICATE OF LEAVE CREDITS: 7. b) RECOMMENDATION:
As of __________________ APPROVED

Vacation Sick Total DISAPPROVED DUE TO ____________________

__________________________________
days days days __________________________________
__________________________________
__________________________
Authorized Official

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

- days with pay __________________________________
- days without pay __________________________________
- others (specify)

SOCORRO V. DELA ROSA, CESO VI

Schools Division Superintendent

INSTRUCTIONS:
1. Application for vacation or sick leave of ONE FULL DAY or more shall be made on this form and to be accomplished in four copies right
after return to duty. HALF DAY- considered as tardiness for A.M. under time for P.M. to be deducted from VACATION LEAVE for non-
teaching and SICK LEAVE for Teachers.
2. Application for VACATION LEAVE/SOLO PARENTS/SPL/MFL/CTO for non- teaching and other forms of leave shall be filed in advance or
whenever possible five (5) days before going on such leave.
3. Application for sick leave filed in advance, or exceeding five days shall be accompanied by a medical certificate in case medical
consultation was not applied of an affidavit shall be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his
authorized leave of absence.
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by clearance from money or property
responsibilities.