PUBLIC ATTORNEY’S OFFICE

APPLICATION FOR LEAVE

1. OFFICE DEPARTMENT/DIVISION 2. NAME LAST , FIRST MIDDLE

3. DATE OF FILING 4. POSITION

6. 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
OTHERS (specify)

2. In case of sick leave

SICK
MATERNITY
OTHERS

c. NUMBER OF WORKING DAYS APPLIED FOR: d. COMMUTATION:

INCLUSIVE DATES:

___________________________
Signature of Applicant

7. DETAILS OF ACTION ON APPLICATION

7.a. CERTIFICATION OF LEAVE CREDITS: b. RECOMMENDATION:
AS OF ___________________

VACATION SICK TOTAL

Days Days Days

_____________________
Authorized Official
Personnel Officer

c. APPROVED FOR: d. DISAPPROVED DUE TO:

___________ Days with pay _____________________
___________ Days without pay _____________________
___________ Others (specify) _____________________

SIGNATURE

AUTHORIZED OFFICIAL
DATE: ____________________________
UBLIC ATTORNEY’S OFFICE
CS Form No. 6
Revised 1984

2. NAME LAST , FIRST MIDDLE

5. SALARY

6. DETAILS OF APPLICATION
6.b. WHERE LEAVE WILL BE SPENT:
1. In case of vacation leave
Within the Philippines
Abroad (specify) ____________
_______________________

2. In case of sick leave

In Hospital (specify) __________
_______________________
Out-Patient (specify) _________
_______________________

Requested
Not Requested

___________________________
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

b. RECOMMENDATION:
Approval
Disapproval due to
___________________________
___________________________

_____________________
Authorized Official

d. DISAPPROVED DUE TO:

_____________________
_____________________
_____________________