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Leave Form

The document is an application for leave form. It requests information from the applicant such as name, signature, position, salary, type of leave being applied for, dates of leave, and leave balances. It also includes sections for the personnel office to indicate approval or disapproval of the leave application and remaining leave balances. The form allows employees to apply for different types of vacation, sick, maternity, paternity, study, or other special leaves.

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maricel bajeyo
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as XLSX, PDF, TXT or read online on Scribd
418 views10 pages

Leave Form

The document is an application for leave form. It requests information from the applicant such as name, signature, position, salary, type of leave being applied for, dates of leave, and leave balances. It also includes sections for the personnel office to indicate approval or disapproval of the leave application and remaining leave balances. The form allows employees to apply for different types of vacation, sick, maternity, paternity, study, or other special leaves.

Uploaded by

maricel bajeyo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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(CSC FORM No. 6 Revised 1985) (CSC FORM No.

6 Revised 1985)

APPLICATION FOR LEAVE APPLICATION FOR LEAVE


TYPE OF LEAVE (Please check appropriate box) TYPE OF LEAVE (Please check appropriate box)
Name: _____________________________________ Name: _____________________________________

Signature: __________________________________ Vacation Leave Signature: __________________________________ Vacation Leave


Position: __________________________________ Within the Philippines Position: __________________________________ Within the Philippines
Monthly Salary: ______________________________ Abroad (Please specify) _____________ Monthly Salary: ______________________________ Abroad (Please specify) _____________
Office/School: _______________________________ Sick Leave Office/School: _______________________________ Sick Leave
Date Filing: _________________________________ Out Patient Date Filing: _________________________________ Out Patient
No. of Working Days Applied for: _________________ In Hospital (Please specify) __________ No. of Working Days Applied for: _________________ In Hospital (Please specify) __________
Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave
Commutation: ( ) Paternity Leave ( ) Study Leave Commutation: ( ) Paternity Leave ( ) Study Leave
Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave
( ) Special Leave Privileges ( ) Special Leave Privileges

FOR PERSONNEL USE ONLY ( ) Monetization of ( ) Solo Parent/Parental FOR PERSONNEL USE ONLY ( ) Monetization of ( ) Solo Parent/Parental
Leave Credits Leave Leave Credits Leave
VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under
Leave Balance R.A. 9262/9710 Leave Balance R.A. 9262/9710
as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs) as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs)
Less: This Leave _______ _______ ________ ( ) n Less: This Leave _______ _______ ________ ( ) n
ACTION ON APPLICATION: ACTION ON APPLICATION:
Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________ Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________

VILMA A MAGBIRAY VILMA A. MAGBIRAY


_______________________________ ______________________________
CERTIFIED BY: School Head CERTIFIED BY: School Head

( ) APPROVED FOR: ______ days with pay ( ) APPROVED FOR: ______ days with pay
ROCHELLE G. OPIANA ______ days without pay ROCHELLE G. OPIANA ______ days without pay
HRMO ( ) DISAPPROVED due to: _________________ HRMO ( ) DISAPPROVED due to: _________________
Administrative Officer IV Administrative Officer IV

ROMMEL R. JANDAYAN, Ed.D, CESE ROMMEL R. JANDAYAN, Ed.D, CESE


OIC-ASDS OIC-ASDS
LF-1-04 LF-1-04

(CSC FORM No. 6 Revised 1985) (CSC FORM No. 6 Revised 1985)

APPLICATION FOR LEAVE APPLICATION FOR LEAVE

Name: _____________________________________ TYPE OF LEAVE (Please check appropriate box) Name: _____________________________________ TYPE OF LEAVE (Please check appropriate box)

Signature: __________________________________ Vacation Leave Signature: __________________________________ Vacation Leave


Position: __________________________________ Within the Philippines Position: __________________________________ Within the Philippines
Monthly Salary: ______________________________ Abroad (Please specify) _____________ Monthly Salary: ______________________________ Abroad (Please specify) _____________
Office/School: _______________________________ Sick Leave Office/School: _______________________________ Sick Leave
Date Filing: _________________________________ Out Patient Date Filing: _________________________________ Out Patient
No. of Working Days Applied for: _________________ In Hospital (Please specify) __________ No. of Working Days Applied for: _________________ In Hospital (Please specify) __________
Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave
Commutation: ( ) Paternity Leave ( ) Study Leave Commutation: ( ) Paternity Leave ( ) Study Leave
Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave
( ) Special Leave Privileges ( ) Special Leave Privileges
( ) Monetization of ( ) Solo Parent/Parental ( ) Monetization of ( ) Solo Parent/Parental
FOR PERSONNEL USE ONLY FOR PERSONNEL USE ONLY
Leave Credits Leave Leave Credits Leave
VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under
Leave Balance R.A. 9262/9710 Leave Balance R.A. 9262/9710
as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs) as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs)
Less: This Leave _______ _______ ________ ( ) n Less: This Leave _______ _______ ________ ( ) n
ACTION ON APPLICATION: ACTION ON APPLICATION:
Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________ Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________

VILMA A MAGBIRAY
_______________________________ VILMA A. MAGBIRAY
______________________________
CERTIFIED BY: School Head CERTIFIED BY: School Head
( ) APPROVED FOR: ______ days with pay ( ) APPROVED FOR: ______ days with pay
ROCHELLE G. OPIANA ______ days without pay ROCHELLE G. OPIANA ______ days without pay
HRMO ( ) DISAPPROVED due to: _________________ HRMO ( ) DISAPPROVED due to: _________________
Administrative Officer IV Administrative Officer IV

ROMMEL R. JANDAYAN, Ed.D, CESE ROMMEL R. JANDAYAN, Ed.D, CESE


OIC-ASDS OIC-ASDS
LF-1-04 LF-1-04
(Please check appropriate box)
(Please check appropriate box)
(CSC FORM No. 6 Revised 1985)

APPLICATION FOR LEAVE


TYPE OF LEAVE (Please check appropriate box)
Name: _____________________________________

Signature: __________________________________ Vacation Leave


Position: __________________________________ Within the Philippines
Monthly Salary: ______________________________ Abroad (Please specify) _____________
Office/School: _______________________________ Sick Leave
Date Filing: _________________________________ Out Patient
No. of Working Days Applied for: _________________ In Hospital (Please specify) __________
Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave
Commutation: ( ) Paternity Leave ( ) Study Leave
Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave
( ) Special Leave Privileges
( ) Monetization of ( ) Solo Parent/Parental
FOR PERSONNEL USE ONLY FOR PERSON
Leave Credits Leave
VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under
Leave Balance R.A. 9262/9710
as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs)
Less: This Leave _______ _______ ________ ( ) n
ACTION ON APPLICATION:
Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________

_________________________
CERTIFIED BY: (Immediate Supervisor)

( ) APPROVED FOR: ______ days with pay


ROCHELLE G. OPIANA ______ days without pay
HRMO ( ) DISAPPROVED due to: _________________
Administrative Officer IV

DR. JOSEPHINE L. FADUL


Schools Division Superintendent
LF-1-04
(CSC FORM No. 6 Revised 1985)

APPLICATION FOR LEAVE


TYPE OF LEAVE (Please check appropriate box)
Name: _____________________________________

Signature: __________________________________ Vacation Leave


Position: __________________________________ Within the Philippines
Monthly Salary: ______________________________ Abroad (Please specify) _____________
Office/School: _______________________________ Sick Leave
Date Filing: _________________________________ Out Patient
No. of Working Days Applied for: _________________ In Hospital (Please specify) __________
Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave
Commutation: ( ) Paternity Leave ( ) Study Leave
Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave
( ) Special Leave Privileges
( ) Monetization of ( ) Solo Parent/Parental
FOR PERSONNEL USE ONLY
Leave Credits Leave
VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under
Leave Balance R.A. 9262/9710
as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs)
Less: This Leave _______ _______ ________ ( ) n
ACTION ON APPLICATION:
Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________

_________________________
CERTIFIED BY: (Immediate Supervisor)

( ) APPROVED FOR: ______ days with pay


ROCHELLE G. OPIANA ______ days without pay
HRMO ( ) DISAPPROVED due to: _________________
Administrative Officer IV

DR. JOSEPHINE L. FADUL


Asst. Schools Division Superintendent
LF-1-04
(CSC FORM No. 6 Revised 1985)

APPLICATION FOR LEAVE


TYPE OF LEAVE (Please check appropriate box)
Name: _____________________________________

Signature: __________________________________ Vacation Leave


Position: __________________________________ Within the Philippines
Monthly Salary: ______________________________ Abroad (Please specify) _____________
Office/School: _______________________________ Sick Leave
Date Filing: _________________________________ Out Patient
No. of Working Days Applied for: _________________ In Hospital (Please specify) __________
Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave
Commutation: ( ) Paternity Leave ( ) Study Leave
Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave
( ) Special Leave Privileges
( ) Monetization of ( ) Solo Parent/Parental
FOR PERSONNEL USE ONLY FOR PERSON
Leave Credits Leave
VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under
Leave Balance R.A. 9262/9710
as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs)
Less: This Leave _______ _______ ________ ( ) n
ACTION ON APPLICATION:
Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________

COMPUTATION: DR. EDUARD C. AMOGUIS


CID - CHIEF
P __________ X ____ X .0481927= P ____________
( ) APPROVED FOR: ______ days with pay
CERTIFIED BY: ______ days without pay
( ) DISAPPROVED due to: _________________

ROCHELLE G. OPIANA
HRMO DR. JOSEPHINE L. FADUL
Administrative Officer IV Asst. Schools Division Superintendent
LF-1-04
(CSC FORM No. 6 Revised 1985)

APPLICATION FOR LEAVE


TYPE OF LEAVE (Please check appropriate box)
Name: _____________________________________

Signature: __________________________________ Vacation Leave


Position: __________________________________ Within the Philippines
Monthly Salary: ______________________________ Abroad (Please specify) _____________
Office/School: _______________________________ Sick Leave
Date Filing: _________________________________ Out Patient
No. of Working Days Applied for: _________________ In Hospital (Please specify) __________
Inclusive Date/s: _____________________________ ( ) Maternity Leave ( ) Rehabilitation Leave
Commutation: ( ) Paternity Leave ( ) Study Leave
Requested: _______ Not Requested: _______ ( ) Forced Leave ( ) Special Emergency Leave
( ) Special Leave Privileges
( ) Monetization of ( ) Solo Parent/Parental
FOR PERSONNEL USE ONLY
Leave Credits Leave
VL SL TOTAL ( ) Terminal Leave ( ) Leave Privilege under
Leave Balance R.A. 9262/9710
as of: __________ _______ _______ ________ ( ) Others: ( ) CTO (Used COCs)
Less: This Leave _______ _______ ________ ( ) n
ACTION ON APPLICATION:
Balance _______ ________ ________ ( ) Approval ( ) Disapproval due to: _________

COMPUTATION: DR. EDUARD C. AMOGUIS


CID - CHIEF
P __________ X ____ X .0481927= P ____________
( ) APPROVED FOR: ______ days with pay
CERTIFIED BY: ______ days without pay
( ) DISAPPROVED due to: _________________

ROCHELLE G. OPIANA
HRMO DR. JOSEPHINE L. FADUL
Administrative Officer IV Asst. Schools Division Superintendent
LF-1-04

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