CS FORM No.

6
Series of 1980
APPLICATION FOR LEAVE

Name (Last) (First) (Middle)

CHING RUTH ARLENE TAN
OFFICE/AGENCY : POSITION SALARY (Monthly)
DPJ- NPS-OPP, Allen, N. Samar Prosecutor I P81,312.00

LEAVE APPLIED FOR (Please Check) :CAUSE (Whether illness, personal, resignation,
etc.
X (Vacation) (Maternity) FIVE DAYS VACATION LEAVE OF ABSENCE

(Sick) (Terminal)

(Force) :

NUMBER OF DAYS : 2 INCLUSIVE DAYS :

MAY 22, 23, 24, 35 & 26, 2017

FIVE (5) working days :

COMMUTATION : :

( X) Requested) :

( ) Not Requested) : RUTH ARLENE TAN-CHING

: (Signature of Applicant)

ACTION (By Office or Agency) : DATE:______________________, 2017

:
: Granting five (5) ROSARIO F. DIAZ
working days vacation leave with pay : Provincial Prosecutor
chargeable against her vacation leave credits, :

ACTION (By Department Head, if necessary): DATE:_______________________, 2016

: SIGNATURE:___________________________

: TITLE:________________________________

1. Application for sick or vacation

leave for :one full day or more BALANCE OF LEAVE CREDITS
shall be made on this form. : As of___________________________, 2016

2. Application for vacation leave shall be : Vacation leave _________________ days

filed advance or whenever possible five :
five days before going on such leave. : Sick Leave ____________________ days
:
3. Application for sick leave filed in :
advance or exceeding five (5) days : CERTIFIED CORRECT:
shall be accompanied by medical :
certificate. :