CSC Form No.

6
Revised 1984
APPLICATION FOR LEAVE

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

BARANGAY SANTO ROSARIO OLD VALENTINO LEONARDO AGULAY
3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)
MARCH 5, 2020 Sangguniang Barangay Kagawad P 9,000.00
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 Within the Philippines

Others (Specify) _____________ Abroad (Specify) __________________

___________________________ _________________________________

Sick 2. IN CASE OF SICK LEAVE

Maternity
Others (Specify) _____________________
___________________________________
6. c) NUMBER OF WORKING DAYS APPLIED
FOR _______________________________
INCLUSIVE DATES _______________________
In Hospital (Specify) ________________
_________________________________
Out Patient (Specify) ________________
_________________________________
6. d) COMMUTATION
Requested Not requested

________________________
(Signature of Applicant)
DETAILS OF ACTION OF APPLICATION

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

as of _______________________________
Approval
Vacation Sick Total
Disapproval due to ___________________
___________________________________

Days Days Days ____________________

REOFLADORA A. TAPANG ____________________________

(Personnel Officer) (Authorized Official)

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

_______________________________________
________________ days with pay _______________________________________
________________ days without pay
________________ others (Specify)

EFREN O. NIEVES
Municipal Mayor