CS Form 6
Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. NAME (Last) (First) (M.I.)
DEPED - DARAGUTAN EAST NHS ACOB WENDELIN E.
3. Date of Filing 4. Position 5. Montly Salary
January 13, 2020 Principal I P 45,269.00
6a. TYPE OF LEAVE 6b. WHERE LEAVE BE SPENT
Vacation a. In case of vacation leave
To seek employment Within the Philippines
Sick Abroad (Specify) __________________
Maternity b. In case sick leave
X Others (Specify) : In Hospital (Specify)
Attend to urgent personal concern
6c. Number of Working Days Applied 6d. COMMUTATION
X Requested Not Requested
For ONE (1) day
Inclusive date(s) January 13, 2020
_______________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7A. Certification of Leave Credits 7b. RECOMMENDATION
As DSO No. ________ _________ days Approval
________ _________ days
Vacation Leave ______ _________ days Disapproved due to
Sick Leave ________ _________ days
________________________________
_________ days used ________________________________
_________ Balance ________________________________
LOU JANE M. NICOLAS ROBERT M. GELACIO
Human Resource Management Officer I Principal In-charge
7c. APPROVED FOR: 7D. DISAPPROVED DUE TO:
___________ Days with pay
___________ Days without pay
___________ Others ( Specify)
_______________
MADELYN L. MACALLING PhD CESO VI
OIC, Schools Division Superintendent