CS FORM 6 CS FORM 6

Revised 1984 APPLICATION FOR LEAVE Revised 1984 APPLICATION FOR LEAVE

1.OFFICIAL AGENCY 2. NAME (Last) (First) (Middle) 1.OFFICIAL AGENCY 2. NAME (Last) (First) (Middle)
DEPED RICOD, RICARDO GALANTO DEPED RICOD, RICARDO GALANTO

3. DATE OF FILING 4. POSITION 5. SALARY 3. DATE OF FILING 4. POSITION 5. SALARY

February 23, 2018 Principal I P February 23, 2018 Principal I P
DETAILS OF APLLICATION DETAILS OF APLLICATION
6.a) TYPE OF LEAVE 6.b) WHERE LEAVE WILL BE SPENT 6.a) TYPE OF LEAVE 6.b) WHERE LEAVE WILL BE SPENT
___Vacation 1) IN CASE OF VACATION LEAVE ___Vacation 1) IN CASE OF VACATION LEAVE
___ Sick ___ Within the Philippine ___ Sick ___ Within the Philippine
___ Maternity ___ Abroad(Specify) ___ Maternity ___ Abroad(Specify)
_√__ Others(Specify) _______________________________ _√__ Others(Specify) _______________________________
2) IN CASE OF SICK LEAVE 2) IN CASE OF SICK LEAVE
______FORCED LEAVE___________ ___ In Hospital(Specify)_______________ ____FORCED LEAVE________ ___ In Hospital(Specify)_______________
6.c) NUMBER OF WORKING DAYS _______________________________ 6.c) NUMBER OF WORKING DAYS _______________________________
APPLIED FOR ___ 1 Day_________________ ___ Out Patient(Specify)_______________ APPLIED FOR ____1 Day___________ ____ ___ Out Patient(Specify)_______________
________________________________ ________________________________
INCLUSIVE DATES__________________ 6.d) COMMUTATION INCLUSIVE DATES__________________ 6.d) COMMUTATION
___ Requested ___ Not requested ___ Requested ___ Not requested
February 26, 2018________ __February 26,2018____
__RICARDO G. RICOD_____ ______RICARDO G. RICOD_________
(Signature of Applicant) (Signature of Applicant)
DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION
7.a)CERTIFICATION OF LEAVE 7.b) RECOMMENDATION 7.a)CERTIFICATION OF LEAVE 7.b) RECOMMENDATION
AS of _______________________________ ___ Approved AS of _______________________________ ___ Approved
____________________________________ ___ Disapproved due to______________ ____________________________________ ___ Disapproved due to______________
______________________________ ______________________________
Vacation Sick Total Vacation Sick Total

Days Days Days _DR. ARNEL C. DOCTOLERO__ Days Days Days _DR. ARNEL C. DOCTOLERO __
OIC- Asst. Schools Division Superintendent OIC- Asst. Schools Division Superintendent

LYSANDER N. ESPEJO LYSANDER N. ESPEJO

Administrative Officer V Administrative Officer V
7.c) APPROVED FOR: 7.d) DISAPPROVED DUE TO: 7.c) APPROVED FOR: 7.d) DISAPPROVED DUE TO:
_____ day/s with pay _____ day/s with pay
_____ day/s without pay _________________________________ _____ day/s without pay _________________________________
_____ other(Specify) _________________________________ _____ other(Specify) _________________________________

GEMMA Q. TACUYCUY, CESO V GEMMA Q. TACUYCUY, CESO V

Schools Division Superintendent Schools Division Superintendent
Date:______________________ Date:______________________
CS FORM 6 CS FORM 6
Revised 1984 APPLICATION FOR LEAVE Revised 1984 APPLICATION FOR LEAVE

1.OFFICIAL AGENCY 2. NAME (Last) (First) (Middle) 1.OFFICIAL AGENCY 2. NAME (Last) (First) (Middle)
DEPED RAFAL, MARICEL RABANG DEPED RAFAL, MARICEL RABANG

3. DATE OF FILING 4. POSITION 5. SALARY 3. DATE OF FILING 4. POSITION 5. SALARY

JANUARY 3, 2018 Teacher I P 19, 620.00 JANUARY 3, 2018 Teacher I P 19,629.00
DETAILS OF APLLICATION DETAILS OF APLLICATION
6.a) TYPE OF LEAVE 6.b) WHERE LEAVE WILL BE SPENT 6.a) TYPE OF LEAVE 6.b) WHERE LEAVE WILL BE SPENT
___Vacation 1) IN CASE OF VACATION LEAVE ___Vacation 1) IN CASE OF VACATION LEAVE
___ Sick ___ Within the Philippine ___ Sick ___ Within the Philippine
_X__ Maternity ___ Abroad(Specify) __X_ Maternity ___ Abroad(Specify)
__ Others(Specify) _______________________________ __ Others(Specify) _______________________________
2) IN CASE OF SICK LEAVE 2) IN CASE OF SICK LEAVE
________________ ___ In Hospital(Specify)_______________ _____ _________ ___ In Hospital(Specify)_______________
6.c) NUMBER OF WORKING DAYS _______________________________ 6.c) NUMBER OF WORKING DAYS _______________________________
APPLIED FOR ___ 60 Days_________________ ___ Out Patient(Specify)_______________ APPLIED FOR ____60 Days___________ ____ ___ Out Patient(Specify)_______________
________________________________ ________________________________
INCLUSIVE DATES__________________ 6.d) COMMUTATION INCLUSIVE DATES__________________ 6.d) COMMUTATION
___ Requested ___ Not requested ___ Requested ___ Not requested
JANUARY 5, 2018 to MARCH 5, 2018 _JANUARY 5, 2018 to MARCH 5, 2018__
__MARICEL R. RAFAL_____ ______MARICEL R. RAFAL_________
(Signature of Applicant) (Signature of Applicant)
DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION
7.a)CERTIFICATION OF LEAVE 7.b) RECOMMENDATION 7.a)CERTIFICATION OF LEAVE 7.b) RECOMMENDATION
AS of _______________________________ ___ Approved AS of _______________________________ ___ Approved
____________________________________ ___ Disapproved due to______________ ____________________________________ ___ Disapproved due to______________
______________________________ ______________________________
Vacation Sick Total Vacation Sick Total

Days Days Days _RICARDO G. RICOD__ Days Days Days _RICARDO G. RICOD __
Principal I Principal I

LYSANDER N. ESPEJO LYSANDER N. ESPEJO

Administrative Officer V Administrative Officer V
7.c) APPROVED FOR: 7.d) DISAPPROVED DUE TO: 7.c) APPROVED FOR: 7.d) DISAPPROVED DUE TO:
_____ day/s with pay _____ day/s with pay
_____ day/s without pay _________________________________ _____ day/s without pay _________________________________
_____ other(Specify) _________________________________ _____ other(Specify) _________________________________

GEMMA Q. TACUYCUY, CESO VI GEMMA Q. TACUYCUY, CESO VI

Schools Division Superintendent Schools Division Superintendent
Date:______________________ Date:______________________