CSC Form 6

Revised 1998

APPLICATION FOR LEAVE

1. Office/Agency 2. Name (Last) (First)
EMB RO8 FABILE KAREN PATRICIA
3. Date of Filing 4. Position
EMS II
DETAILS OF APPLICATION
6. A) Type of Leave 6. B) Where Leave will be spent:
Vacation 1. In case of Vacation Leave
To seek employment Within the Philippines
Others (Specify) Abroad (Specify)

Sick 2. In case of Sick Leave

Maternity In hospital (Specify)
Others (Specify)

6. C) Number of Working Days applied for: 6. D) Commutation

Requested
Inclusive Dates

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. A) Certification of Leave Credits 7. B) Recommendation:
as of

Vacation Sick Total Approval

Disapproval due to
days days days

Authorized Official Authorized Official

7. C) Approved for: 7. D) Disapproved due to:
days with pay
days without pay

Signature

LETECIA R. MACEDA
Regional Director
Date: _________________
 (Middle)
ALMOCERA
5. Salary

will be spent:
Vacation Leave
Within the Philippines
broad (Specify)

Sick Leave
n hospital (Specify)

Not Requested

ignature of Applicant
ON

isapproval due to

uthorized Official