CSC Form No.

6
Revised 1984 APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

3. DATE OF FILING 4. POSITION 5. SALARY

6. DETAILS OF APPLICATION

6.1 TYPE OF LEAVE 6.2 WHERE LEAVE WILL BE SPENT:

Vacation IN CASE OF VACATION LEAVE

To seek employment Within the Philippines
Others (Specify) Abroad (Specify)

Sick IN CASE OF SICK LEAVE

In Hospital (Specify)
Maternity Out Patient (Specify)

Others (Specify) 6.4 COMMUTATION

xX
XX
6.2 NUMBER OF WORKING DAYS APPLIED FOR Not Requested
Requested
INCLUSIVE DATES

(Signature of Applicant)
7. DETAILS OF ACTION APPLICATION
7.1 CERTIFICATION OF LEAVE CREDITS 7.2 RECOMMENDATION

As of Approval
Vacation Sick Total Disapproval due to

Days Days Days

(Personnel Officer) Presiding Judge

7.3 APPROVED FOR: 7.4 DISAPPROVED DUE TO:

days with pay

days without pay
others (Specify)

(Signature)

Executive Judge