APPLICATION FOR LEAVE

2. NAME (LAST)

1.OFFICE / DISTRICT
(MIDDLE)
Dep.Ed-Cavite Gen. Trias II Dist
3.DATE OF FILING
SALARY ( MONTHLY)

(FIRST)

4. POSITION

5.

DETAIL OF APPLICATION
6.A) TYPES OF LEAVE
SPENT

6.B) WHERE LEAVE WILL BE

VACATION
SICK LEAVE

IN CASE OF

TO SEEK EMPLOYMENT
PHILIPPINES
OTHERS (Specify)__________
( Specify)_______
_____________________________________

WITHIN THE
ABROAD
_______________________________

SICK
SICK LEAVE

IN CASE OF

MATERNITY
HOSPITAL ( Specify)

IN
____________________

________
OTHERS ( Specify)

OUTPATIENT

( Specify)
______________________________________

______________________________

6. NUMBER OF WORKING DAYS

APPLIED FOR______________________
Not Requested
INCLUSIVE DAYS__________________
_______________________

6.D) COMMUTATION
Requested

___________________________________
Signature of the Applicant
DETAILS OF ACTION OF APPLICATION
7.A) CERTIFICATION OF LEAVE CREDITS
7. B) RECOMMENDATION
AS OF___________________________
APPROVAL
VACATION
DUE TO_______

SICK

LEAVE

DISAPPROVAL
_________________

______________
Days

Days

NORMA C. MELO
CANTADA, Ed.D.

Days

PETRA P.

Planning Officer II
Supervisor
OIC, Administrative Officer V
7. APPOVED FOR:
TO:
_______ DAYS WITH PAY
_______ DAY WITH OUT PAY
_______ OTHERS ( Specify)

___________________________
(AUTHORIZED OFFICIAL)

District

7.D) DISAPPROVED DUE