APPLICATION FOR

LEAVE
CSC Form no.6
Revised 2003
1. Office/ Agency 2. Name (Last) (First) (Middle Name)
Dep. Ed. MOLAVE WEST TACTACON CHRISTY ALO
3. Date of Filling 4. Position 5. Salary (Monthly)
Teacher –I 20, 179.00
DETAILS OF APPLICATION
6. (A.) Type of Leave 6. (B) Where leave will be spent
( ) Vacation 1. In case of vacation leave
( ) Sick Leave With Pay ( ) Within the Philippines
( ) to seek employment ( ) Abroad ( Specify ) _________________________________
( ) Maternity 2. In case of sick leave
( ) Other ( Specify) ( ) In hospital ( specify) ( ) Out patient ( specify)
______________________________
______________________

6. (C.) Number of Working 6. (D.) Computation

Days Applied for ______ ( ) Requested ( ) Not requested
Inclusive dates:
From : _________
To: _________

To offset VSC

CHRISTY A. TACTACON
Signature of Applicant

DETAILS OF ACTION OF APPLICATION

7. (A) Certification of leave 7. (B) Recommendation
Credits as of ____________ ( ) Approval
( ) Disapproval due to
Vacation Sick Total

Days Days Days

ALEX A. GARCES
School Head
BERNADETH R. GULBEN
Administrative Officer IV
ARCELI B. ALONZO
Public Schools District Supervisor

7. (C) (Personnel Officer) 7. (D) Disapproved due to: __________________

Approval for ________________________________
_____________ days with pay ________________________________
_____________ days without pay ________________________________
_____________ others ( specify) ________________________________

JEANELYN A. ALEMAN, Ph.D., Ll.B.

OIC, Schools Division Superintendent
(Authorized Official)
INSTRUCTION: Date:

1.Application for vacation or sick for one full day or more shall be on form.
2.Application for vacation 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 (5) days shall be accompanied by a medical certificate with
documentary stamp issued by a Private Physician and their License Number should be clearly.
 decsspro@mozcom.com

APPLICATION FOR
LEAVE
CSC Form no.6
Revised 2003
1. Office/ Agency 2. Name (Last) (First) (Middle Name)
Dep. Ed. MOLAVE WEST

3. Date of Filling 4. Position 5. Salary (Monthly)

DETAILS OF APPLICATION
6. (A.) Type of Leave 6. (B) Where leave will be spent
( ) Vacation 1. In case of vacation leave
( ) Sick ( ) Within the Philippines
( ) to seek employment ( ) Abroad ( Specify ) _________________________________
( ) Maternity 2. In case of sick leave
( ) Other ( Specify) ( ) In hospital ( specify) _______________________________
( ) Out patient ( specify) ______________________________

6. (C.) Number of Working 6. (D.) Computation

Days Applied for ( ) Requested ( ) Not requested
Inclusive dates:
From :
To:
To offset VSC
_______________________
Signature of Applicant

DETAILS OF ACTION OF APPLICATION

7. (A) Certification of leave 7. (B) Recommendation
Credits as of ____________ ( ) Approval
( ) Disapproval due to
Vacation Sick Total

Days Days Days

AMANDO R. MIER
BERNADETH R. GULBEN
Administrative Officer IV
Principal -I
(Authorized Official)

7. (C) (Personnel Officer) 7. (D) Disapproved due to: __________________

Approval for ________________________________
_____________ days with pay ________________________________
_____________ days without pay ________________________________
_____________ others ( specify) ________________________________

DR. DANNY B. CORDOVA, CESE

OIC, Asst. Schools Division Superintendent
(Authorized Official) __________________
INSTRUCTION: Date
1.Application for vacation or sick for one full day or more shall be on form.
2.Application for vacation 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 (5) days shall be accompanied by a medical certificate with
documentary stamp issued by a Private Physician and their License Number should be clearly.
decsspro@mozcom.com
 APPLICATION FOR LEAVE

CSC Form no.6

Revised 1984

1. Office/ Agency 2. Name (Last) (First) (Middle Name)

Dep. Ed. DIVISION OF ZDS

3. Date of Filling 4. Position 5. Salary (Monthly)

DETAILS OF APPLICATION
6. (A.) Type of Leave 6. (B) Where leave will be spent
( ) Vacation 1. In case of vacation leave
( ) Sick ( ) Within the Philippines
( ) to seek employment ( ) Abroad ( Specify )
( ) Maternity _________________________________
( ) Other ( Specify) 2. In case of sick leave
( ) In hospital ( specify)
_______________________________
( ) Out patient ( specify)
_______________________________

6. (C.) Number of Working 6. (D.) Computation

Days Applied for ( ) Requested
Inclusive dates: ( ) Not requested
From : _______To: ________

To offset VSC
_________________________________
Offset to service credit Signature of Applicant

DETAILS OF ACTION OF APPLICATION

7. (A) Certification of leave 7. (B) Recommendation
Credits as of ____________ ( ) Approval
Vacation Sick Total ( ) Disapproval due to __________________

Days Days Days

BERNADETH R. GULBEN
AOIV-Records

7. (C) (Personnel Officer) 7. (D) Disapproved due to: _________________

Approval for ________________________________
_____________ days with pay ________________________________
_____________ days without pay ________________________________
_____________ others ( specify) ________________________________

HILDA U . BABON
Schools Division Superintendent
(Authorized Official) __________________
INSTRUCTION: Date
1.Application for vacation or sick for one full day or more shall be on form.
2.Application for vacation 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 (5) days shall be accompanied by a medical certificate with
documentary stamp issued by a Private Physician and their License Number should be c
 Republic of the Philippines
Department of Education
Region IX, Zamboanga Peninsula
Division of Zamboanga del Sur
MOLAVE WEST DISTRICT

(Address of Station)

(Date)

The Division Superintendent of Schools

Division of Zamboanga del Sur
Pagadian City

SIR :
I have the honor to apply for reinstatement from (vacation / maternity / sick / study leave of
absence effective on . I was on leave for the period
from to . The forms of pertinent papers marked (X) below are
herewith submitted as required.

____________ Original copy of the Birth Certificate of my child.

____________ Medical Certificate with P15.00 documentary stamps duly accomplished by government
physician certifying that I am now physically fit to return to duty. Transcript of official
school records dated _________________________ if from study leave.

That the following dates are furnished for the information of that office.

1. My leave was approved for the period from _____________________

to ____________________ inclusive.
2. I delivered on _________________________________.
3. That I extended my leave from ___________________to ____________________.
4. Number of service credits used to effect this leave was ______________ days.
5. That last balance of service credits after deduction the same from this leave will
be _____________ days.

Name of substitute to be dropped ___________________________________________.

Hoping that this application be given due course.

Very truly yours,

____________________________
Teacher’s Signature
Present Salary :________________
Employee No.: _______________

1st Indorsement
DISTRICT OF MOLAVE WEST

Respectfully forwarded to the Division Superintendent of Schools,

Pagadian City, recommending approval of the reinstatement of Mr./Mrs.
Effective on .

DR. DANNY B. CORDOVA, CESE

OIC, Asst. Schools Division Superintendent
(Authorized Official)
 Republic of the Philippines
Department of Education
Region IX, Zamboanga Peninsula
Division of Zamboanga del Sur
MOLAVE WEST DISTRICT

(Address of Station)

(Date)
The Division Superintendent of Schools
Division of Zamboanga del Sur
Pagadian City

MADAM :
I have the honor to apply for reinstatement for of
absence effective on . I was on leave for the period from
to . The forms of pertinent papers marked (X)
below are herewith submitted as required.

____________ Original copy of the Birth Certificate of my child.

____________ Medical Certificate with P15.00 documentary stamps duly accomplished by government
physician certifying that I am now physically fit to return to duty. Transcript of official
school records dated _________________________ if from study leave.

That the following dates

are furnished for the information of that office.

6. My leave was approved for the period from _____________________

to ____________________ inclusive.
7. I delivered on _________________________________.
8. That I extended my leave from ___________________to ____________________.
9. Number of service credits used to effect this leave was ______________ days.
10. That last balance of service credits after deduction the same from this leave will
be _____________ days.

Name of substitute to be dropped ___________________________________________.

Hoping that this application be given due course.

Very truly yours,

Signature of applicant
Present Salary : P
Employee No.:

1st Indorsement
DISTRICT OF MOLAVE WEST
Molave, Zamboanga del Sur

Respectfully forwarded to the Division Superintendent of Schools,

Pagadian City, recommending approval of the reinstatement of Mr./Mrs.
Effective on .

JEANELYN A. ALEMAN, Ph.D., Ll.B.

OIC, Schools Division Superintendent
(Authorized Official)