APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

DOH-RO8, Candahug, Palo, Leyte YANSON RENE VALLENA
3. DATE OF FILLING 4. POSITION 5. SALARY (MONTHLY)
19-Feb-18 Accountant III PHP 42,099.00

DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT

Vacation In case of Vacation Leave
To seek employment Within the Philippines
Others (specify) Abroad (specify)

Sick In caseof Sick Leave

Maternity -- In Hospital (specify)
Others (specify) Emergency -- Out Patient (specify)
leave (stranded) due to flood & heavy rains
6. c). Number of working days a One (1) day 6. d). COMMUTATION
(Inclusive
dates) February 14, 2018 Requested x Not requested

RENE V. YANSON
Signature of Applicant
DETAILS OF ACTION ON APPLICATION

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

Balance as of:

Vacation Sick Total Approved

Disapproved

Days Days Days

IMELDA Q, CREER MARIA ROSARIO D. BALBOA, MM

Administrative Officer V/Head HRMU Chief Administrative Officer , MSD

7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO:

days w/ pay
days w/o pay
others (specify)
MINERVA P. MOLON, MD, MPH, FPPA, CESO III
Director IV
N
ant

LBOA, MM
er , MSD
 APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

DOH-RO8, Candahug, Palo, Leyte YANSON RENE VALLENA
3. DATE OF FILLING 4. POSITION 5. SALARY (MONTHLY)
5-Nov-18 Accountant III PHP 42,099.00

DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT

Vacation In case of Vacation Leave
To seek employment Within the Philippines
x Others (specify) Forced Leave Abroad (specify)

Sick In caseof Sick Leave

Maternity -- In Hospital (specify)
Others (specify) -- Out Patient (specify)

6. c). Number of working days a Two (02) days 6. d). COMMUTATION

(Inclusive
dates) November 22 & 23, 2018 Requested x Not requested

RENE V. YANSON
Signature of Applicant
DETAILS OF ACTION ON APPLICATION

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

Balance as of:

Vacation Sick Total Approved

Disapproved

Days Days Days

IMELDA Q, CREER MARIA ROSARIO D. BALBOA, MM

Administrative Officer V/Head HRMU Chief Administrative Officer , MSD

7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO:

days w/ pay
days w/o pay
others (specify)
MINERVA P. MOLON, MD, MPH, FPPA, CESO III
Director IV
N
ant

LBOA, MM
er , MSD
 APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

DOH-RO8, Candahug, Palo, Leyte YANSON RENE VALLENA
3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)
3-Dec-18 Accountant III PHP 42,099.00

DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT

Vacation In case of Vacation Leave
To seek employment Within the Philippines
x Others (specify) Forced Leave Abroad (specify)

Sick In caseof Sick Leave

Maternity -- In Hospital (specify)
Others (specify) X -- Out Patient (specify)
Due to acute rhinitis
6. c). Number of working days a Two(02) days 6. d). COMMUTATION
(Inclusive
dates) December 20 & 21, 2018 Requested x Not requested

RENE V. YANSON
Signature of Applicant
DETAILS OF ACTION ON APPLICATION

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

Balance as of:

Vacation Sick Total Approved

Disapproved

Days Days Days

IMELDA Q, CREER MARIA ROSARIO D. BALBOA, MM

Administrative Officer V/Head HRMU Chief Administrative Officer , MSD
7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO:
days w/ pay
days w/o pay
others (specify)

MINERVA P. MOLON, MD, MPH, FPPA, CESO III

Director IV
TION FOR LEAVE

S OF APPLICATION

RENE V. YANSON
Signature of Applicant
ACTION ON APPLICATION

MARIA ROSARIO D. BALBOA, MM

Chief Administrative Officer , MSD
OLON, MD, MPH, FPPA, CESO III
Director IV
 APPLICATION FOR LEAVE
CSC Form No. 6
Revised 1984

1. OFFICE/AGENCY: 2. LAST NAME FIRST MIDDLE

DOH-RO8, Candahug, Palo, Leyt
3. DATE OF FILING: 4. POSITION 5. SALARY (MONTHLY)

DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT

Vacation In Case of Vacation Leave
To seek employment Within the Philippines
Other ( Specify Abroad (specify) ____________________________

Sick In case of Sick Leave

Maternity In Hospital (specify)
Other ( Specify) Outpatient (specify) _____________________

6. c). Number of working days applied for:_______ 6. d). COMMUTATION

( inclusive dates ) Requested Not requested

_________________________________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION

7. a). 7. b). RECOMMENDATION

Balance as of: _____________________________________________

Vacation Sick Total Approved

Disapproved

Days Days Days

IMELDA Q. CREER
Administrative Officer V/Head, HRMU DMO IV

7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO:

Days w/ pay
Days w/out pay
Others ( Specify )

ROMMEL C. FRANCISCO, MD, MPH

DMO V/ Provincial DOH Officer
 ION FOR LEAVE

S OF APPLICATION

Abroad (specify) ____________________________

Outpatient (specify) _____________________

__________________________________________
Signature of Applicant
CTION ON APPLICATION

DMO IV
C. FRANCISCO, MD, MPH
V/ Provincial DOH Officer
MONTHLY COMPENSATION & PREMIUMS CONTRIBUTIONS

Monthly Annual

Salary

Hazard (25% of Salary)

Subsistence Allow. Per workday 50

Laundry Allow. 150

GSIS-Social Insurance (12%)

Pag-Ibig Premium 100

Medicare (See Philhealth Table)