CSC FORM NO.

6 Revised 1991

APPLICATION FOR LEAVE

OFFICE/AGENCY SURNAME FIRST NAME MIDDLE NAME

LGU TANAUAN
Date of Filing: June

LEBRIA
POSITION TITLE

MARK DAVE

NATIVIDAD

14, 2013

MONTHLY SALARY

CLERK I
WHERE LEAVE WILL BE SPENT:

DETAILS OF APPLICATION
TYPE OF LEAVE:

( ) VACATION ( ) To seek employment ( / ) Others (specify): Mandatory Leave ( ) SICK ( ) MATERNITY ( ) OTHERS (Specify):

( ) IN CASE OF VACATION LEAVE ( ) Within the Philippines ( ) Abroad (specify): ____________________ ___________________________ ( ) IN CASE OF SICK LEAVE ( ) In Hospital (specify):_________ __________________________ ( ) Out-Patient (specify):________ __________________________ COMMUTATION: ( ) Requested ( ) Not Requested

NUMBER OF WORKING DAYS APPLIED FOR:

Inclusive Date: June 13, 2013 ___________________________ (Signature of Applicant)

CERTIFICATION OF LEAVE CREDITS: PARTICULARS Balance as of Less: Leave Applied for Remaining Balance VACATIOIN SICK TOTAL RECOMMENDATION: ( X ) Approved: ( ) Disapproved due to ________________ _______________________________

HON. CATALINA R. KAPUNAN RAIDA P. BARANDA HRMO APPROVED FOR:

_______/ _______ DAYS WITH PAY _______________DAYS WITHOUT PAY _______________OTHERS (Specify) DEPARTMENT HEAD

DISAPPROVED DUE TO:

___________________________ ___________________________ ___________________________

ATTY. AGAPITO P. PAGAYANAN JR.

Municipal Mayor