APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

3. DATE OF FILLING 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
Others (specify) Abroad (specify)

Sick In caseof Sick Leave

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

6. c). Number of wkg. Days applied for 6. d). COMMUTATION

Inclusive dates Requested Not requested

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. a). CERTIFICATION OF LEAVE CREDITS 7. b). RECOMMENDATION
as of

Vacation Sick Total Approved

Disapproved

Days Days Days

Administrative Officer Authorized Official

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

days w/ pay
days w/o pay
others (specify)
Regional Director