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APPLICATION FOR LEAVE

C.S. Form 6
1. Office/Agency

2. NAME

3. Date of Filing

4. Position

(Last)

(First)

(Middle)

5. Salary (Monthly)

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE
6. b) WHERE LEAVE WILL BE SPENT?
( ) Vacation
( ) Sick
1) IN CASE OF VACATION LEAVE
( ) Maternity
( ) Within the Philippines
( ) Others (Specify) _______________
( ) Abroad (Specify)__________________
______________________________
________________________________
________________________________
6. c) NO OF WORKING DAYS APPLIED FOR
2) IN CASE OF SICK LEAVE
____________________________________
( ) In Hospital (Specify)_______________
INCLUSIVE DATES__________________
_________________________________
____________________________________
3) COMMUTATION
____________________________________
( ) Requested
( ) Not Requested
________________________
Signature of Applicant
DETAILS OF ACTION OF APPLICATION
7. a) CERTIFICATION OF LEAVE CREDIT
7. b) RECOMMENDATION
As of _____________________________
( ) Approval
( ) Disapproval due to _____________
Vacation
Sick
Total
______________________________
______________________________
______________________________
Days
Days
Days
________________________
Personnel Officer

________________________
(Authorized Official)

7. c. APPROVAL FOR:
_____________ days with pay
_____________ days without pay
_____________ Others (Specify)

7. d) DISAPPROVAL DUE TO:


____________________________________
____________________________________
____________________________________

___________________________
(Signature)
_______________
Date

__________________________________
(Authorized Official)
By : MJOcenar Calingonan ES, 2012-2013

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