CSC Form No.

6
Revised 1984

APPLICATION FOR LEAVE

Office/Agency
2. Name (Last)
Angono MPS
Godalle
3. Date of Filing
4. Rank
PO2
August 23, 2016
7.a. Type of Leave
( ) Vacation
( ) Sick
( ) Maternity
( ) Paternity
( ) Mandatory
(x) Special Privilege

(First)

(Middle Name)
Jeffrey
Jimenez
5. Status Appmnt
6. Salary
7. Badge Nr
Permanent
P 14, 834.00
210644
7. b. Where Leave will be Spent
( ) In Hospital (Specify)
( ) Out Patient (Specify)
7.c. Specific address while on leave:
Angono, Rizal
Contact Nr: 09435137413

7.d. Computation of Leave Credits

(/ )- Requested
( )- Not Requested
7.e. Number of Working Days
Three (3) Days
Inclusive Dates: August 23 25, 2016
PO2 Jeffrey Jimenez Godalle
Signature
DETAILS OF ACTION ON APPLICANT
8.a. Certification of Leave Credits as of: 8.b. Recommendation
December 1, 2010 August 23, 2016
( ) Approved
__________________________________
Vacation
Sick
Total
85.924

85.924

171.848
( ) Disapproved due to
__________________________________

FLORANTE D YU
Police Chief Inspector
Chief, PHRDD Branch
8.c. Approved for:
_________________ Days with Pay
_________________ Days without Pay

ADRIANO T ENONG JR
Police Senior Superintendent
Acting Provincial Director, Rizal PPO
8.d. Disapproved for
______________________________________
______________________________________

BERNABE MENDOZA BALBA

Police Senior Superintendent
Regional Chief of the Directorial Staff