Republic of the Philippines

Province of Southern Leyte

Municipality of Macrohon
BARANGAY UPPER VILLA JACINTA

Control Number: __________________

Date Received at Mayor’s Office: __________________
Received by: __________________

APPLICATION FOR LEAVE

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

Upper Villa Jacinta Olacao Geralyn Muldez
3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)
7/6/2018 SK Chair woman 4,031.00
6. a.) TYPE OF LEAVE (please check) 6. b.) where LEAVE WILL BE SPENT
□ Vacation Leave □ Mandatory or Forced Leave 1. In case of Vacation Leave:
□ Sick Leave □ Maternity or Paternity Leave □ Within the Philippines
□ Under time □ TERMINAL LEAVE □ Abroad (Pls. Specify) ____________________
□ MONETIZATION □ Others (Pls. Specify) _________________________ ________________________
□ SPECIAL LEAVE PRIVILEGE
□ Birthday Leave □ Government Transaction Leave 2. In case of Sick Leave:
□ Wedding/Anniversary Leave □ Calamity Leave □ In the hospital (Specify)
□ Enrollment Leave □ Relocation Leave □ Out-patient (Specify)
□ Graduation Leave □ Accident Leave
□ Funeral/Mourning Leave □ Hospitalization Leave
6. c.) Number of Working Days Applied for: 6. d.) Communication
________________________________________________________ □ Requested □ Not Requested
Inclusive Dates ______________________________________
________________________________________________________ GERALYN M. OLACAO
Signature of Applicant
DETAILS OF ACTION ON APPLICATION

7.a.) COMPUTATION AND CERTIFICATION 7. b.) RECOMMENDATION:

OF LEAVE CREDITS: □ APPROVED
□ DISAPPROVED due to:
_____________________________________________
_____________________________________________
VACATION SICK
Balance as of
Leave Earned from
TOTAL
Less: Leave now applied
Balance as of

ALEX T. AMOLO ALEX T. AMOLO

Punong Barangay Punong Barangay
(Authorized Official)

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

________________________________________ day/s without pay ___________________________________________
________________________________________ day/s with pay ___________________________________________
________________________________________ other (specify)

ALEX T. AMOLO
Punong Barangay
(Signature of Authorized Official)

INSTRUCTIONS:
1. Application for Vacation or Sick Leave for one (1) full day shall be made on this form and to be accomplished in triplicate.
2. Application for Vacation shall be filed in advance or exceeding five (5) days before going on such leave.
3. Application for Sick Leave filed in advance or exceeding five (5) days shall be accomplished with a medical certificate. In case medical
consultation was not availed, an affidavit should be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to received his/her salary corresponding to the period of
his/her unauthorized leave of absence.
5. Application for leave of absence for thirty (30) calendar days or more shall be accomplished by a Clearance of money and property
accountabilities.