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Sick Leave Application Guidelines

This document is an application form for requesting leave from an office or agency. It collects information such as the applicant's name, position, salary, type of leave being requested (e.g. vacation, sick, maternity), number of working days for the leave, inclusive dates, and places the leave will be spent. It also includes sections for certifying the applicant's leave credits, recommendations on the application, and details on an approval or disapproval. Instructions are provided noting the process for applying for different types of leaves and required documentation.

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Genie Besina Sina-on
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178 views2 pages

Sick Leave Application Guidelines

This document is an application form for requesting leave from an office or agency. It collects information such as the applicant's name, position, salary, type of leave being requested (e.g. vacation, sick, maternity), number of working days for the leave, inclusive dates, and places the leave will be spent. It also includes sections for certifying the applicant's leave credits, recommendations on the application, and details on an approval or disapproval. Instructions are provided noting the process for applying for different types of leaves and required documentation.

Uploaded by

Genie Besina Sina-on
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

CS Form No.

6
Revised 1984
APPLICATION FOR LEAVE

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

3. DATE OF FILING 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
To seek employment Within the Philippines
Others (Specify) Abroad (Specify)

Sick 2.) INCASE OF SICK LEAVE


Maternity In Hospital (Specify)
Others (specify) Out Patient (Specify)

6. c) NUMBER OF WORKING DAYS6. d) COMMUTATON


APPLIED FOR: ____ Requested Not Requested
INCLUSIVE DATE/S

(Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION


as of Approved
Vacation Sick Total Disapproval due to
_________

Days Days Days

ELYSANDRIA S. GARO FELVITA L. LIPARDO


Administrative Officer V (Principal/School Head)
(Personnel Officer) (Authorized Official)

7. C APPROVED FOR: 7. d) DISAPPROVED DUE TO:


day/s with pay _________________________________
days without pay _________________________________
others (specify)

___________________________
(Signature)
____________________________
Schools Division Superintendent
(AUTHORIZED OFFICIAL)

Date __________________________
INSTRUCTIONS
1. Application for vacation and sick leave of one full day or more shall be made on this form and to be
accomplished at least in triplicate.
2. Application for vacation leave shall be filled in advance or whenever possible five (5) days before going on
such leave.
3. Application for sick leave filed in advance, or exceeding five days shall be accompanied by a medical
certificate. In case medical consultation was not availed of, an affidavit shall be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to
the period of this unauthorized leave of absence.
5. An application of leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance
from money or property responsibilities.

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