APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1.

OFFICE/AGENCY
(MIDDLE)

3. DATE OF FILING

2. NAME

(LAST)

(FIRST)

4. POSITION (STATUS OF APPMT)

6.a) TYPE OF LEAVE

1) IN CASE OF VACATION LEAVE
VACATION

5. SALARY

(DETAILS OF APPLICATION)
6.b) WHERE LEAVE WILL BE SPENT

To seek employment

Within the Philippines

Others (Specify)

Abroad (Specify)

SICK
In Hospital (Specify)
Maternity

2) IN CASE OF SICK LEAVE

Others (Specify)

Out Patient:

6.c) NUMBER OF WORKING DAYS APPLIED FOR

Inclusive Date

(Specify)
6.d) COMMUTATION

Requested

Not Requested

Signature of Applicant
Present address
DETAILS ON ACTION OF APPLICATON
7. a) CERTIFICATION OF LEAVE CREDITS
7. b) RECOMMENDATION
As of
Approved
VACATION
Disapproved

SICK

TOTAL

(Authorized Official)
(Personnel Officer)
APPROVED FOR
Days with pay
Days without pay
Others (Specify)
SUPPLY OFFICER/DSAO

APPROVED:

Signature
(Authorized Official)