CSC Form No.

6
Revised 1994
APPLICATION FOR LEAVE
Regional Human Rights Commission
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

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

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

( ) Vacation (1) IN CASE OF VACATION LEAVE
( ) Maternity ( ) Within Philippines
( ) Others (Specify) ( ) Abroad (Specify)

( ) Sick (2) IN CASE OF SICK LEAVE

( ) Maternity ( ) In Hospital (Specify)
( ) Others (Specify)
( ) Out patient (Specify)

6.c NUMBER OF WORKING DAYS 6.d COMMUTATION

Applied for : ( ) Requested
Inclusive Dates: ( ) No Requested

(Signature of Applicant)

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

AS OF ( ) Approval
( ) Disapproved due to

BALANCE AS OF V.L. S.L. TOTAL

LESS THIS LEAVE

BALANCE AS OF

RHODEMIL IMAM BELONGHILOT (Name and Signature of the Approval)

Admin. Assistant V/HRMO, designate (Position / Designation)

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

Days with pay

Days without pay
Others (Specify)

ATTY. BAI ASHRAFIA AYMEE A. BIRUAR

Attorney VI/Executive Director,designate

INSTRUCTIONS

1. Application for vacation leave for one full day or more shall be made on this Form to be accomplished at least in duplicate.
2. Application for vacation leave shall be filed in advance or when never possible (5) days before going on such leave.
3. Application for sick leave shall be filed in advance or exceeding five (5) days shall be accompanied by a medical certificate.
In case medical consultation was not availed of an affidavit should be executed by the applicant.
4. An employee who is absent without approved leave shall be eve shall not be entitled to receive his salary corresponding to the
period his unathorized leave of absence.
5. An applicant for leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance money and
property accountable.