CSC FORM NO.

6 (1985) APPLICATION FOR LEAVE

Name: __________________________________ Vacation Special Leave

Signature: _______________________________
Position: ________________________________ Within the Philippines Abroad
Monthly Salary: Php ______________________
Office/Division: __________________________ Sick Out Patient ( Specify )
Date of Filing: ___________________________
No. of Working Days Applied for: ___________ In Hospital ( Specify )
Inclusive Dates: __________________________
__________________________ Terminal Leave
Commutation ____________________________
ACTION ON APPLICATION
/ Requested Recommending:

FOR PERSONNEL USE ONLY: Approval

Disapproval due to ______________

Leave credits V.L. S.L. TOTAL
As of ________ ______ ______ _______
Enjoyed Leave ______ ______ _______ ____________________________________
TOTAL ______ ______ _______ HEAD OF OFFICE
Less, this Leave ______ ______ _______
Balance ______ ______ _______
______ ______ _______ Approved for: Disapproved
_________ days with pay due to ________
CERTIFIED CORRECT: _________ days w/o pay _____________

ELINA A. VIVAS Date: ____________ ELMER L. JAVELONA

Admin. Officer, III Municipal Mayor

CSC FORM NO. 6 (1985) APPLICATION FOR LEAVE

Name: __________________________________ Vacation Special Leave

Signature: _______________________________
Position: ________________________________ Within the Philippines Abroad
Monthly Salary: Php ______________________
Office/Division: __________________________ Sick Out Patient ( Specify )
Date of Filing: ___________________________
No. of Working Days Applied for: ___________ In Hospital ( Specify )
Inclusive Dates: __________________________
__________________________ Terminal Leave
Commutation ____________________________
ACTION ON APPLICATION
/ Requested Recommending:

FOR PERSONNEL USE ONLY: Approval

Disapproval due to ______________

Leave credits V.L. S.L. TOTAL
As of ________ ______ ______ _______
Enjoyed Leave ______ ______ _______ ____________________________________
TOTAL ______ ______ _______ HEAD OF OFFICE
Less, this Leave ______ ______ _______
Balance ______ ______ _______
______ ______ _______ Approved for: Disapproved
_________ days with pay due to ________
CERTIFIED CORRECT: _________ days w/o pay _____________

ELINA A. VIVAS Date: ____________ ELMER L. JAVELONA

Admin. Officer, III Municipal Mayor