CSC Form 6Revised 1998 APPLICATION FOR LEAVE 1. OFFICE/AGENCY 2. NAME Employee No.: __________ DIVISION OF SURIGAO DEL SUR DIOLA SHARON ROSE S. Department of Education Last Name First Name M.I. 3. Date of Filing 4. Position 5. Salary December , 2017 Senior High School Nurse II Php 27, 565.00 DETAILS OF APPLICATION 6. A) Type of Leave 6. B) Where Leave will be spent: Vacation 1. In case of Vacation Leave To seek employment Within the Philippines Others (Specify) Abroad (Specify) Sick 2. In case of Sick Leave Maternity In hospital (Specify) Others (Specify) Out patient (Specify) 6. C) Number of Working Days applied f6. D) Commutation 3 days X Requeste Not Requested Inclusive Dates December 27,28,29,2017 SHARON ROSE S. DIOLA Signature of Applicant over Printed Name DETAILS OF ACTION ON APPLICATION 7. A) Certification of Leave Credits 7. B) Recommendation: as of Vacation Sick Total Approval Disapproval due to day/s day/s day/s ALICIA S. LLEGA Personnel Officer Principal III 7. C) Approved for: 7. D) RECOMMENDATION days with pay Approval days without pay Disapproval due to: Other (specify) NORBEN T. MOLDEZ Public School District in Charge Date: SGOD (Authorized Official) Date: _________________ . URBIZTONDO Chief. Signature ELVIRA S. Requested ct in Charge .