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Form 6 Leave Application Form

This document is an application form for requesting leave from a job. It collects information such as the office, name of applicant, date of filing, position and salary of the applicant. It asks for details of the leave request such as type of leave (e.g. vacation, sick, maternity), where the leave will be spent, number of working days requested, and whether commutation is requested. The form is then signed by the applicant. It provides sections for certifying leave credits and balances, recommending approval or disapproval of the request, and specifying the approved leave details. Instructions at the bottom provide guidance on filing leave applications.

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Yhena Chan
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119 views2 pages

Form 6 Leave Application Form

This document is an application form for requesting leave from a job. It collects information such as the office, name of applicant, date of filing, position and salary of the applicant. It asks for details of the leave request such as type of leave (e.g. vacation, sick, maternity), where the leave will be spent, number of working days requested, and whether commutation is requested. The form is then signed by the applicant. It provides sections for certifying leave credits and balances, recommending approval or disapproval of the request, and specifying the approved leave details. Instructions at the bottom provide guidance on filing leave applications.

Uploaded by

Yhena Chan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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CS FORM NO.

6
Revised 1984

APPLICATION FOR LEAVE

1. OFFICE/DISTRICT 2. NAME (LAST) (FIRST) (MIDDLE)

3. DATE OF FILING 4.POSITION 5. SALARY (MONTHLY)

D E TAI LS O F APPLI CAT I O N


6. A) TYPE OF LEAVE B) WHERE LEAVE WILL BE SPENT
(1) IN CASE OF VACATION LEAVE
Vacation Within the Philippines
Abroad (specify)_______________
To seek employment _____________________________
Other (specify) __________________
(2) IN CASE OF SICK LEAVE
Sick In Hospital (specify) ____________
Maternity _____________________________
Others (specify) Out Patient (specify)
___________
_____________________________________ ____________________________
C) NUMBER OF WORKING DAYS APPLIED FOR D) COMMUTATION
_________________ days
INCLUSIVE DATES _____________________ Requested Not Requested

_________________________________________
(Signature of Applicant)
D E TAI LS O F AC T I O N O N APPLI CAT I O N

7. A) CERTIFICATION OF LEAVE CREDITS B) RECOMMENDATION


Approved
TOTAL
TOTAL EARNED
EARNED LEAVE
LEAVE VL
VL SL
SL
AsAs
of of ______________
______________ __________
__________ _________
_________
TOTAL
TOTAL LEAVE
LEAVE ENJOYED:
ENJOYED: __________
__________ _________
_________ Disapproved due to____________
Balance as of
Balance as of __________
__________ _________
_________
Less thisthis
Less application
application __________
__________ _________
_________
Balance as
Balance as of of __________
__________ _________
_________ __________________________
(Authorized Official)

(Personnel Officer)
C) APPROVED FOR D) DISAPPROVED DUE TO
______________days
______________ dayswith
withpay
pay ______________________________________
______________ days without
______________ days without pay pay ______________________________________
______________Other
______________ Others (specify)
(specify)

GERMELINA H. PASCUAL
Schools Division Superintendent
DATE: ______________

INSTRUCTIONS
1. Application for vacation or sick leave for one full day or more shall be made on this Form and to be accomplished
at least in duplicate.
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.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the
period of his unauthorized leave of absence.
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance
from money and property accountabilities.

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