CS Form No.

6
Revised 1984

APPLICATION FOR LEAVE

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

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

DETAILS OF APPLICATION
6.1 TYPE OF LEAVE 6.2 WHERE LEAVE WILL BE SENT
[ ] Vacation IN CASE OF VACATION LEAVE
[ ] To seek employment [ ] Within the Philippines
[ ] Others (Specify) ( ) [ ] Abroad (Specify)

[x] Sick IN CASE OF SICK LEAVE

[ ] Maternity [ ] In Hospital (Specify) ___________
[ ] Others (Specify) [ ] Out-Patient (Specify)

6.3 NUMBER OF WORKING DAYS APPLIED FOR 6.4 COMMUTATION

ONE (1) day [ ] Requested [ ] Not Requested
INCLUSIVE DATES
March 8, 2019
(Signature of Applicant)
For Court Personnel

DETAILS OF ACTION ON APPLICATION

(To be filled-up by the Employees’ Leave Division)

7.1 CERTIFICATION OF LEAVE CREDITS 7.2 RECOMMENDATION

As of _______________________________

[ ] Approval
Vacation Sick Total
[ ] Disapproval

Days Days Days

(Personnel Officer) (Acting Presiding Judge)

7.3 APPROVED FOR: 7.4 DISAPPROVED DUE TO:

____________ days with pay
____________ days without pay
____________ Others (Specify)

(Signature)

(Executive Judge)