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APPLICATION FOR LEAVE

1. OFFICE / AGENCY 2. NAME (Last) (First) (Middle)

3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

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)

6.c) Number of WORKING DAYS APPLIED FOR: 6.d) COMMUTATION

INCLUSIVE DATES: Requested

Not Requested

(Authorized Official)

DETAILS OF ACTION ON APPLICATION

7.a) CERTIFICATION OF LEAVE CREDITS: 7.b) RECOMMENDATION

As of Approved

VL SL TOTAL Disapproved due to:

(Authorized Official)

8.a) Approved for: 8.b) Disapproved due to:

Days with Pay

Days without Pay

Others

ATTY. SIKINI C. LABASTILLA


OIC-H.R.M.O

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