APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1.

OFFICE/AGENCY

2. LAST NAME

3.

DATE OF FILLING

4. POSITION

FIRST

MIDDLE
5. SALARY (MONTHLY)

DETAILS OF APPLICATION
6. a). TYPE OF LEAVE

6. b). WHERE LEAVE WILL BE SPENT

Vacation

In case of Vacation Leave

To seek employment

Within the Philippines

Others (specify)

Abroad (specify)

Sick

In caseof Sick Leave

Maternity

-- In Hospital (specify)

Others (specify)

-- Out Patient (specify)

6. c). Number of wkg. Days applied for

Four ( 4 ) Day
Inclusive dates
August 31, 2007/ September 3-5, 2007

6. d). COMMUTATION
Requested

Not requested

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. a). CERTIFICATION OF LEAVE CREDITS
as of
Vacation

Sick

7. b). RECOMMENDATION

Total

Approved
Disapproved

Days

Days

Days

JOVENCIO M. VELOSO
Administrative Officer V
7. c). APPROVED FOR:
days w/ pay
days w/o pay
others (specify)

Authorized Official

7. d). DISAPPROVED DUE TO:

Regional Executive Director