7/26/2019 CSC FORM6

1/1

1. Office/Agency Employee ID/Number:

DepED Northern Samar School/Office:Cawayan National High School District:

(detailed at Galutan National High School) Employee Contact Number:

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

Sick Leave In case of Sick Leave, please specify the place of recovery.

Maternity Leave

Others (Please specify)

Commutation Requested

7. Number of working days applied: Not Requested

7. A. Certification of Leave Credits 7. B. Recommendation

7. C. APPROVED FOR: 7. D. DISAPPROVED due to:

days with pay

days without pay

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.

Inclusive dates:

APPLICATION FOR LEAVE

(Signature over Printed Name of Employee)

(Signature over Printed Name of Immediate Head)

Vacation Leave

CreditsSick Leave Credits

Total Leave

Credits

Vacation Leave

CreditsSick Leave Credits

Total Leave

Credits

Republic of the Philippines

DEPARTMENT OF EDUCATION

Regional Office No. VIII (Eastern Visayas)

DIVISION OF NORTHERN SAMAR

Catarman, Northern Samar

MANUEL P. ALBAO, CESO VSchools Division Superintendent

DETAILS OF ACTION ON APPLICATION

Administrative Officer

CSC Form 6

(Revised 2015)

3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding the period his authorized leave

of absence.

GORDA, RAYMOND ARNIO

May 2, 2016

Secondary School Teacher III

Php 22,328.00

Study Leave

RAYMOND A. GORDA

TERESITA C. MARINO

0010819

(detailed at Galutan National High School)

09093837760

Catarman IV

April 4, 2016 - March 31, 2017

Administrative Officer