for leave of 15 days and below please use this form

Republic of the Philippines

Department of Education
DIVISION OF ROMBLON

APPLICATION FOR LEAVE

CSC Form 6 (Revised 2015)
1.Office / Agency Employee ID/Number: _______________________
DepED – Schools Division Office School/Office: _______________________
of Romblon District: _______________________
Brgy. Capaclan, Romblon, Romblon Employee Contact No.: _______________________

2.Name: ___________________________________________________________________________
(Last Name) (First Name) (Middle Name)

3.Date of Filing: 4.Position: ____________________________________

____________________________ 5.Monthly Salary: ______________________________

6.a. Type of Leave: 6.b. Where leave will be spent in case of Vacation Leave?
__________ Vacation Leave ___________________________________________
__________ To seek employment ___________________________________________
__________ Forced Leave ___________________________________________
__________ Special Privilege Leave ___________________________________________
__________ Sick Leave In case of Sick Leave, please specify the place of recovery.
__________ Maternity Leave ___________________________________________
__________ Others (please specify) ___________________________________________
________________________ Commutation:
________________________ __________ Requested
__________ Not Requested
7. Number of working days applied
________________________
Inclusive dates: ___________________________________________
from: __________________ (Signature over Printed Name of Employee)
to: ___________________

___________________________________________
(Signature over Printed Name of Immediate Head)

DETAILS OF ACTION ON APPLICATION

7.A. Certification of Leave Credits: 7.B. Recommendation:
as of ________________________
Vacation Sick Leave Total Leave Vacation Sick Leave Total Leave
Leave Credits Credits Credits Leave Credits Credits Credits

MARICEL G. MONTOJO
Administrative Officer V
7.C. APPROVED FOR: 7.D. DISAPPROVED due to:

__________ days with pay ______________________________

__________ days without pay ______________________________

RUFINO B. FOZ
Chief Education Supervisor
OIC-Office of the Assistant Schools Division Superintendent
1.Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2.Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical
certificate.
3.An employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding the period of his
unauthorized leave of absence.
for leave of 16 days and above please use this form

Republic of the Philippines

Department of Education
DIVISION OF ROMBLON

APPLICATION FOR LEAVE

CSC Form 6 (Revised 2015)
1.Office / Agency Employee ID/Number: _______________________
DepED – Schools Division Office School/Office: _______________________
of Romblon District: _______________________
Brgy. Capaclan, Romblon, Romblon Employee Contact No.: _______________________

2.Name: ___________________________________________________________________________
(Last Name) (First Name) (Middle Name)

3.Date of Filing: 4.Position: ____________________________________

____________________________ 5.Monthly Salary: ______________________________

6.a. Type of Leave: 6.b. Where leave will be spent in case of Vacation Leave?
__________ Vacation Leave ___________________________________________
__________ To seek employment ___________________________________________
__________ Forced Leave ___________________________________________
__________ Special Privilege Leave ___________________________________________
__________ Sick Leave In case of Sick Leave, please specify the place of recovery.
__________ Maternity Leave ___________________________________________
__________ Others (please specify) ___________________________________________
________________________ Commutation:
________________________ __________ Requested
__________ Not Requested
7. Number of working days applied
________________________
Inclusive dates: ___________________________________________
from: __________________ (Signature over Printed Name of Employee)
to: ___________________

___________________________________________
(Signature over Printed Name of Immediate Head)

DETAILS OF ACTION ON APPLICATION

7.A. Certification of Leave Credits: 7.B. Recommendation:
as of ________________________
Vacation Sick Leave Total Leave Vacation Sick Leave Total Leave
Leave Credits Credits Credits Leave Credits Credits Credits

MARICEL G. MONTOJO
Administrative Officer V
7.C. APPROVED FOR: 7.D. DISAPPROVED due to:

__________ days with pay ______________________________

__________ days without pay ______________________________

MARIA LUISA D. SERVANDO, Ph.D., CESO VI

Schools Division Superintendent

1.Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished in four copies.
2.Application for vacation leave shall be filed in advance. In case of sick leave exceeding five days shall be accompanied with medical
certificate.
3.An employee who is absent without approved leave shall not be entitled to receive his/her salary corresponding the period of his
unauthorized leave of absence.
for travel abroad please use this form

Republic of the Philippines

Department of Education
DIVISION OF ROMBLON

APPLICATION FOR LEAVE

CSC Form 6 (Revised 2015)
1.Office / Agency Employee ID/Number: _______________________
DepED – Schools Division Office School/Office: _______________________
of Romblon District: _______________________
Brgy. Capaclan, Romblon, Romblon Employee Contact No.: _______________________

2.Name: ___________________________________________________________________________
(Last Name) (First Name) (Middle Name)

3.Date of Filing: 4.Position: ____________________________________

____________________________ 5.Monthly Salary: ______________________________

6.a. Type of Leave: 6.b. Where leave will be spent in case of Vacation Leave?
__________ Vacation Leave ___________________________________________
__________ To seek employment ___________________________________________
__________ Forced Leave ___________________________________________
__________ Special Privilege Leave ___________________________________________
__________ Sick Leave In case of Sick Leave, please specify the place of recovery.
__________ Maternity Leave ___________________________________________
__________ Others (please specify) ___________________________________________
________________________ Commutation:
________________________ __________ Requested
__________ Not Requested
7. Number of working days applied
________________________
Inclusive dates: ___________________________________________
from: __________________ (Signature over Printed Name of Employee)
to: ___________________

___________________________________________
(Signature over Printed Name of Immediate He,ad)

DETAILS OF ACTION ON APPLICATION

7.A. Certification of Leave Credits: 7.B. Recommendation:
as of ________________________
Vacation Sick Leave Total Leave Vacation Sick Leave Total Leave
Leave Credits Credits Credits Leave Credits Credits Credits

MARICEL G. MONTOJO
Administrative Officer V
7.C. APPROVED FOR: 7.D. DISAPPROVED due to:

__________ days with pay ______________________________

__________ days without pay ______________________________

MARIA LUISA D. SERVANDO, Ph.D., CESO VI

Schools Division Superintendent

BENJAMIN D. PARAGAS, CESO V

Director III
OIC-Office of the Regional Director