CSC Form No.

6
Revised 1984

APPLICATION FOR LEAVE

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

3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

DETAILS OF APPLICATION
6.1 TYPE OF LEAVE 6.2 WHERE LEAVE WILL BE SPENT
[ ] Vacation IN CASE OF VACATION LEAVE
[ ] To seek employment [ ] Within the Philippines
[ ] Others (Specify) [ ] Abroad (Specify)

[ ] Sick IN CASE OF SICK LEAVE

[ ] Maternity [ ] In Hospital (Specify)
[ ] Others (Specify) [ ] Out-Patient (Specify)

6.3. NUMBER OF WORKING DAYS APPLIED FOR 6.4 COMMUTATION

[ ] Requested [ ] Not Requested
INCLUSIVE DATES

(Signature of Applicant)
For Court Personnel

DETAILS OF ACTION ON APPLICATION

(To be filled-up by the Employees Leave Division)
7.1 CERTIFICATION OF LEAVE CREDITS 7.2 RECOMMENDATION
As of
[ ] Approval
Vacation Sick Total [ ] Disapproval due to

Days Days Days

(Personnel Officer) (Acting Presiding Judge)

7.3 APPROVED FOR: 7.4 DISAPPROVED DUE TO:

days with pay
days without pay
Others Specify
 (Signature)

VICTORIA C. FERNANDEZ - BERNARDO

(Executive Judge)