APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First) (Middle)

3. Date of Filling 4. Position 5. Salary (Monthly)

DETAILS OF APPLICATION
6. a.) Type of Leave 6. b.) Where leave will be spent
(1) In case of Vacation Leave
Vacation
Within the Philippines
To seek employment
Abroad (specify)______________________
Others (specify) ___________________ ___________________________________
_________________________________ (2) In Case of Sick Leave

Sick In Hospital (specify)____________________

Maternity ____________________________________
Out Patient (specify)___________________
Others(specify) ____________________________________
_________________________________ 6. d.) Commutation
6. c.)Number of Working Days Applied for 4
Requested Not Requested
Inclusive Dates:

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. a.) Certification of Leave Credits as of 7. b.) Recommendation
___________________________________
Approval
Vacation Sick Total
Disapproval due to ______________________
Days Days Days ______________________________________
______________________________________

7. c.) Approved for: 7. d.) Disapproved due to:

______________ Days with pay _________________________________________
______________ Days without pay __________________________________________
______________ Others (specify)
Date:___________________