Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Division of Batangas
District of Mataasnakahoy
PAARALANG ELEMENTARYA NG NANGKAAN
Mataasnakahoy
APPLICATION FOR LEAVE
1. OFFICE/AGENCY :2. NAME (Last) (First) (Middle)
3. DATE OF FILING :4. POSITION :5. MONTHLY SALARY
DETAILS OF APPLICATION
6. a.) TYPE OF LEAVE (1.) INCASE OF VACATION LEAVE
Vacation With in the Philippines
To seek employment __________ Abroad (Specify) _________________
Others( Specify) _____________ ________________________________
b.) ____________________________ (2.) IN CASE OF SIK LEAVE
Sick In Hospital (Specify) _____________
Maternity _______________________________
Others (Specify) ______________ Out Patient (Specify) ____________
c.) ________________________________ d.) COMPUTATION______________
NUMBER OF WORKING DAYS APPLIED FOR
Requested Not Requested
__________________________________
INCLUSIVE DATES: _______________ ______________________________
(Signature of Applicant)
7. a.) CERTIFICATION OF LEAVE CREDITS 7. b.) RECOMMENDATION
As of ___________________________ Approval ________________
Disapprove due to _________
VACATION SICK TOTAL
DAYS DAYS DAYS
_________________________________ _________________________________
(Personnel Officer) (Authorized Official)
7. c.) APPROVED FOR: 7. d.) DISAPPROVED DUE TO:
____________ days with pay ___________________________
____________ days with out pay ___________________________
____________ Others (specify) ___________________________
______________________________________________
(Signature)
Schools Division Superintendent