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Leave Form Sample Deped

This document is an application for leave submitted by Steven Keith Mueda, a Nurse II in the Department of Education Division of Iloilo. He is applying for 1 day of vacation leave from December 23, 2019. The application provides details of the type of leave requested, where the leave will be spent, the number of days applied for, and a signature. It also includes a section to certify the applicant's leave credits and make a recommendation on the application, which is then approved or disapproved with the signature of the assistant schools division superintendent.

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steven keith Estilo
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137 views

Leave Form Sample Deped

This document is an application for leave submitted by Steven Keith Mueda, a Nurse II in the Department of Education Division of Iloilo. He is applying for 1 day of vacation leave from December 23, 2019. The application provides details of the type of leave requested, where the leave will be spent, the number of days applied for, and a signature. It also includes a section to certify the applicant's leave credits and make a recommendation on the application, which is then approved or disapproved with the signature of the assistant schools division superintendent.

Uploaded by

steven keith Estilo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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CS Form No.

6
Revised 1984

Department of Educatio
Region VI – Western Visayas
SCHOOLS DIVISION OF ILOILO
La Paz, Iloilo City

________________________________________________________________________________________________
APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)
Dep. Ed., Division of Iloilo ESTILO STEVEN KEITH MUEDA
3. DATE OF FILING 4. POSITION 5. SALARY(Monthly)
DECEMBER 26, 2019 NURSE II P 30, 531.00
DETAILS OF APPLICATION
6. A) TYPE OF LEAVE: 6. B) WHERE LEAVE WILL BE SPENT:
(1) IN CASE OF VACATION LEAVE
Vacation Within the Philippines
To seek employment Abroad (Specify)__________________
Others (specify) _______ (2) IN CASE OF SICK LEAVE
___________________ _ In hospital (Specify) _______________
Sick ________________________________
Maternity / Paternity Out Patient
Others (Specify)
_____________________________

6. C) NUMBER OF WORKING DAYS APPLIED FOR. 6. D) COMMUNICATION


APPLIED FOR_____1(ONE)__ _ Request
INCLUSIVE DATES ____DECEMBE R23, 2019___ Not Requested
_______________________________
Signature of Applicant
Employee Number 6385254
Date of Original Appointment March 15, 2018

DETAILS OF ACTION ON APPLICATION


CERTIFICATION OF LEAVE CREDITS RECOMMENDATION
7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of Approval

Vacation Sick CTO/COC PL Others TOTAL Disapproval


EARNED ___________________________
SPENT ___________________________
BALANCE

_________________________________
JOSE MARIE T. BEDRO
Administrative Officer II
OIC-Administrative Officer V

__________________________
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:
_____________days with pay _____________________________
_____________days without pay _____________________________
_____________others (Specify)

________________________________
AZUCENA T. FALALES, Ph. D.
Assistant Schools Division Superintendent
Date:_________________

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