CS FORM NO. 6 CS FORM NO.

6
Revised 1984 Revised 1984

APPLICATION FOR LEAVE APPLICATION FOR LEAVE

1. OFFICE AGENCY 2. NAME (Last) (First) (Middle) 1. OFFICE AGENCY 2. NAME (Last) (First) (Middle)

3. Date of Filing 4. Position 5. SALARY (Monthly) 3. Date of Filing 4. Position 5. SALARY (Monthly)

DETAILS OF APPLICATION DETAILS OF APPLICATION

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
[ ] To seek employment [ ] Within the Philippines [ ] To seek employment [ ] Within the Philippines
[ ] Other (Specify) [ ] Abroad (Specify) [ ] Other (Specify) [ ] Abroad (Specify)

[ ] SICK (2) IN CASE OF SICK LEAVE [ ] SICK (2) IN CASE OF SICK LEAVE
[ ] Maternity [ ] In Hospital (Specify) [ ] Maternity [ ] In Hospital (Specify)
[ ] Other (Specify) [ ] Out-patient (Specify) [ ] Other (Specify) [ ] Out-patient (Specify)

6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION 6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION
FOR: [ ] Requested [ ] Not Requested FOR: [ ] Requested [ ] Not Requested
INCLUSIVE DATES INCLUSIVE DATES

(Signature of Applicant) (Signature of Applicant)

DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION 7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of [ ] Approval As of [ ] Approval
Vacation Sick Total [ ] Disapproval due to Vacation Sick Total [ ] Disapproval due to
 (Personnel Officer) (Authorized Official) (Personnel Officer) (Authorized Official)

7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO: 7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO:
_ Days with pay _ Days with pay
_ Days without pay _ Days without pay
_ Others (Specify) _ Others (Specify)

___________________ ___________________
Signature Signature
Date: _________________ Date: _________________
CS FORM NO. 6 CS FORM NO. 6
Revised 1984 Revised 1984

APPLICATION FOR LEAVE APPLICATION FOR LEAVE

DepEd - So.Leyte DepEd - So.Leyte

1. OFFICE AGENCY 2. NAME (Last) (First) (Middle) 1. OFFICE AGENCY 2. NAME (Last) (First) (Middle)

3. Date of Filing 4. Position 5. SALARY (Monthly) 3. Date of Filing 4. Position 5. SALARY (Monthly)

DETAILS OF APPLICATION DETAILS OF APPLICATION

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
[ ] To seek employment [ ] Within the Philippines [ ] To seek employment [ ] Within the Philippines
[ ] Other (Specify) [ ] Abroad (Specify) [ ] Other (Specify) [ ] Abroad (Specify)

[ ] SICK (2) IN CASE OF SICK LEAVE [ ] SICK (2) IN CASE OF SICK LEAVE
[ ] Maternity [ ] In Hospital (Specify) [ ] Maternity [ ] In Hospital (Specify)
[ ] Other (Specify) [ ] Out-patient (Specify) [ ] Other (Specify) [ ] Out-patient (Specify)

6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION 6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION
FO [ ] Requested [ ] Not Requested FOR [ ] Requested [ ] Not Requested
INCLUSIVE DATES INCLUSIVE DATES

(Signature of Applicant) (Signature of Applicant)

DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION 7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of [ ] Approval As of [ ] Approval
Vacation Sick Total [ ] Disapproval due to Vacation Sick Total [ ] Disapproval due to

(Personnel Officer) (Authorized Official) (Personnel Officer) (Authorized Official)

7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO: 7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO:
_ Days with pay _ Days with pay
_ Days without pay _ Days without pay
_ Others (Specify) _ Others (Specify)

GENIS S. MURALLOS, Ed.,D. CESO V GENIS S. MURALLOS, Ed.,D. CESO V

Signature Signature
Date: _________________ Date: _________________
CS FORM NO. 6 CS FORM NO. 6
Revised 1984 Revised 1984

APPLICATION FOR LEAVE APPLICATION FOR LEAVE

DepEd - So.Leyte DELIGERO ELIZABETH M. DepEd - So.Leyte DELIGERO ELIZABETH M.

1. OFFICE AGENCY 2. NAME (Last) (First) (Middle) 1. OFFICE AGENCY 2. NAME (Last) (First) (Middle)
April 15, 2019 EPS April 15, 2019 EPS
3. Date of Filing 4. Position 5. SALARY (Monthly) 3. Date of Filing 4. Position 5. SALARY (Monthly)

DETAILS OF APPLICATION DETAILS OF APPLICATION

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
[ ] To seek employment [ ] Within the Philippines [ ] To seek employment [ ] Within the Philippines
[ ] Other (Specify) [ ] Abroad (Specify) [ ] Other (Specify) [ ] Abroad (Specify)

[ ] SICK (2) IN CASE OF SICK LEAVE [ ] SICK (2) IN CASE OF SICK LEAVE
[ ] Maternity [ ] In Hospital (Specify) [ ] Maternity [ ] In Hospital (Specify)
[ / ] Other (Specify) [ ] Out-patient (Specify) [ / ] Other (Specify) [ ] Out-patient (Specify)
Charge to COC Charge to COC

6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION 6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION
FO 3 days [ ] Requested [ ] Not Requested FOR 3 days [ ] Requested [ ] Not Requested
INCLUSIVE DATES INCLUSIVE DATES
April 22, 23, 24, 2019 April 22, 23, 24, 2019

(Signature of Applicant) (Signature of Applicant)

DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION 7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of [ ] Approval As of [ ] Approval
Vacation Sick Total [ ] Disapproval due to Vacation Sick Total [ ] Disapproval due to

(Personnel Officer) (Authorized Official) (Personnel Officer) (Authorized Official)

7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO: 7. c) APPROVED FOR 7. d) DISAPPROVED DUE TO:
_ Days with pay _ Days with pay
_ Days without pay _ Days without pay
_ Others (Specify) _ Others (Specify)

GENIS S. MURALLOS, Ed.,D. CESO V GENIS S. MURALLOS, Ed.,D. CESO V

Signature Signature
Date: _________________ Date: _________________