APPLICATION FOR LEAVE

1. Office/Agency 2. Name (last) First Middle

DEPED – Miabas NHS ABANADOR SHERYL ROYO

3. Date of Filling 4. Position 5. Salary

TEACHER I P22, 600.00

DETAILS OF APPLICATION

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

[ ] Vacation  In case of vacation leave
[ ] To seek employment [ ] Within the Philippines
[ ] Others (specify) [ ] Abroad (specify)
……………………………………………..
……………………………………….  IN CASE OF SICK LEAVE
[ ] Sick [ ] In hospital (specify)
[ ] Maternity
[ ] Others (specify) ……………………………………
[ ] Out Patient (specify)
……………………………………….
c) Number of Working Days applied for ……………………………………
COMMUTATION
………………………………………………. [ ] Requested [ ] Not Requested

Inclusive Dates ……………………………………………..

Signature of the Applicant

DETAILS OF ACTION APPLICATION

7. a) Certification of Leave Credits b) Recommendation

as of …………………………………………. [ ] Approval
[ ] Disapproval due to
Vacation Sick Total
……………………………………………..
days days days

FELIPE P. RAMIREZ II
…………………………………. Authorized Official
Personnel Officer
d) DISAPPROVED TO
b) APPROVED FOR
……………………………. days with pay ……………………………………………..
………………………….... days without pay
……………………………. Others (specify)

________________________________
Signature

_________________________________
Authorized Official

Date: …………………………………………………