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Leave Application Form Template

This document is an application for leave from the Philippine Statistics Authority. It contains fields for the applicant's personal information and details of the leave request such as type of leave, number of days, and where the leave will be spent. There are also sections for certifying the applicant's leave credits, recommendations on the application, and approval or disapproval of the request by supervisors.

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Ma. Carmina Pascasio
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40 views1 page

Leave Application Form Template

This document is an application for leave from the Philippine Statistics Authority. It contains fields for the applicant's personal information and details of the leave request such as type of leave, number of days, and where the leave will be spent. There are also sections for certifying the applicant's leave credits, recommendations on the application, and approval or disapproval of the request by supervisors.

Uploaded by

Ma. Carmina Pascasio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

REPUBLIC OF THE PHILIPPINES

PHILIPPINE STATISTICS AUTHORITY

APPLICATION FOR LEAVE


APPLICANT'S PROFILE
1. NAME: (LAST) (FIRST) (MIDDLE)

2. Position/Designation: 3. Monthly Salary:


4. Unit/Section/Division/Office:
DETAILS OF APPLICATION
5. Date of Filing:
6.A. TYPE OF APPLICATION 6.C. WHERE LEAVE WILL BE SPENT:
[ ]VACATION 1 IN CASE OF VACATION LEAVE
( ) Forced Leave ( ) Within the Philippines
( ) To seek for employment ( ) Abroad, (specify):
( ) Other, (specify) : ______________
2 IN CASE OF SICK LEAVE
[ ] Sick Leave ( ) In Hospital
(specify):
[ ] Maternity
( ) Out Patient
[ ] Others, (specify): Filial (specify):

6.B. NUMBER OF WORKING DAYS FOR: 6.D. COMMUTATION

Inclusive Dates: _________________________ ( ) Requested ( x ) Not Requested

____________________________________________
Signature over printed name of the applicant
DETAILS OF ACTION TO THE APPLICATION
7.A. CERTIFICATION OF LEAVE CREDITS: 7.B. RECOMMENDATION
As of ( ) Approved
( ) Disapproved
Vacation Sick Total (specify): ________________________
________________________________

CHRISTINE JOANN L. GONZAGA DULCE M. DIONISIO


Administrative Officer I Supervising Statistical Specialist

7.C. APPROVED BY:

days with pay _____days without pay


others (specify)

APPROVED/DISAPPROVED:

NORMAN L. BUNDALIAN
Chief Statistical Specialist

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