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APPLICATION FOR LEAVE

CC Form No. 6
Revised 1994

Date Entered Service: ________________________


9

1. OFFICE/AGENCY

2. NAME

(Last)

3. DATE OF FILLING

4.RANK/ POSITION & STATUS OF APPMT

6a. TYPE OF LEAVE


( ) VACATION
( ) To seek employment
( ) Others (specify)
______________________________
______________________________
______________________________
(
(
(
_

(First)

(Middle)

(QLFR)

( Badge Nr)

5. SALARY

6b. WHERE WILL BE SPEND


IN CASE OF VACATION LEAVE:
( ) Within the Philippines
( ) Abroad (Specify)

) SICK
) MATERNITY
) Others (Specify)
________ _____________

IN CASE OF SICK LEAVE:


(
) In Hospital (Specify)___________________
(
) Out Patient (Specify) __________________

7c. NO OF WORKING DAYS APPLIED FOR:

d. COMMUTATION

_________________________

(
(

) Requested
) Not Requested

INCLUSIVE DATES: _____________________


_______________________
(Signature of Applicant)
ADDRESS:
____________________________________
____________________________________

DETAILS OF ACTION OF APPLICATION


8a. CERTIFICATION OF LEAVE CREDITS
As of _______________________
Vacation

Sick

Total

______________________________
Admin PNCO
9a. APPROVED FOR:
_____________ Days with pay
_____________ Days without pay
_____________ Others (Specify)

b. RECOMMENDATION
(
(

) Approval
) Disapproved due to:

____________________________________

__________________________________
(Authorized Official)
b. DISAPPROVED DUE TO:
_____________________
_____________________
_____________________

________________________________
FERNANDO H MENDEZ, JR
Police Senior Superintendent (DSC)
Provincial Director, BULPPO
Date:___________________

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