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CS Form 6
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Revised 1984
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APPLICATION FOR LEAVE
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1. OFFICE/ AGENCY
2. COMPLETE NAME
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DEP ED, ALBAY DIVISION
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DISTRICT
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SCHOOL(LAST NAME)(FIRST NAME)(MIDDILE NAME)
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3. DATE OF FILING
4. POSITION
5. SALARY (MONTHLY)
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DETAILS OF APPLICATION
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6.a. TYPE OF LEAVE
6.b. WHERE LEAVE WILL BE SPENT
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[ ]Vacation
(1) IN CASE OF VACATION LEAVE
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[ ] To seek employment
[ ] Philippines
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[ ] Others (Specify)
[ ] Abroad (Specify)
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[ ]
Sick (Specify Illness)
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(1) IN CASE OF SICK LEAVE
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[ ] In Hospital (Specify)
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[ ]Maternity
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[ ] Out Patient (Specify)
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Others (Specify)
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c. COMMUTATION
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Number of Working Days Applied For
[ ] Requested[ ] Not Requested
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____________________________________
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Inclusive Dates:
(Signature of Applicant)
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__________________
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Employee No. Sta. Code
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DETAILS OF APPLICATION
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7.a. CERTIFICATION OF LEAVE CREDITS AS OF
7.b. RECOMMENDATION
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VACATIONSICKTOTAL[ ] Approval
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 [ ] Disapproved due to
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EVELYN R. LIM
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Human Resource Management OfficerAuthorized Official
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7.c. APPROVED FOR
7.d. DISAPPROVED DUE TO:
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days with pay
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days without pay
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Others (Specify)
(Signature)
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____________________________________
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Authorized Official
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APPROVED:
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(Signature)
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AUTHORIZED OFFICIAL
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INSTRUCTIONS
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1. Application for vacation or sick leave for one full day or more shall be made on the Form 6 and to
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be accomplished at leact in duplicate.
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2. Application for vacation leave shall be filed in advance of whenever possible five (5) days before
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going on such leave.
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3. Application of sick leave file in advance or exceeding five (5) days shall be accompanied by a
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medical cerificate. In case medical consultation was not availed of, an affidavit should be
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execurted by the applicant.
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4. An employee who is absent without approved leave shall not be entitled to receive his/her salary
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corresponding to the period of his unauthorized leave of absence.
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5. An application for leave of absence fot thirty (30) calendar days of more shall be accompanied
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by a clearance from money and property responsibilities.
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October 15, 1984
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