Leave Form2

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CSC FORM NO. 6 CSC FORM NO.

6
Revised 1984 Revised 1984

APPLICATION FOR LEAVE APPLICATION FOR LEAVE


ID No.: 03-22-0042 ID No.: 03-22-0042
1. OFFICE AGENCY 2. NAME (Last) (First) (Middle) 1. OFFICE AGENCY2. NAME (Last) (First) (Middle)
CGSO Villafuerte Cecilia O. CGSO Villafuerte Cecilia O.
3. DATE OF FILING 5. SALARY (MONTHLY) 3. DATE OF FILING 5. SALARY (MONTHLY)
Feb. 06, 2020 Admin. Assistant III Feb. 06, 2020 Admin. Assistant III
DETAILS OF APPLICATION

6. a) TYPE OF LEAVE: 6. b) WHERE LEAVE WILL BE SPENT: 6. a) TYPE OF LEAVE: 6. b) WHERE LEAVE WILL BE SPENT:

Vacation (1) IN CASE OF VACATION LEAVE 0 Vacation (1) IN CASE OF VACATION LEAVE
To seek employment Within the Philippines To seek employment Within the Philippines
X Others (Specify) Abroad (Specify) X Others (Specify) Abroad (Specify)
SLP SLP

Sick In Hospital (Specify) 0 Sick In Hospital (Specify)


Maternity Maternity
Others (Specify) Out Patient (Specify) Others (Specify) Out Patient (Specify)

6. c) NUMBER OF WORKING DAYS APPLIED FOR 6. d) COMMUTATION 6. c) NUMBER OF WORKING DAYS APPLIED FOR 6. d) COMMUTATION
1 day X Requested Not Requested 1 day X Requested Not Requested
INCLUSIVE DATES February 13, 2020 INCLUSIVE DATES February 13, 2020
0

(Signature of Applicant) (Signature of Applicant)

DETAILS OF ACTION ON APPLICATION DETAILS OF ACTION ON APPLICATION


7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION 7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION

X Approval X Approval
VACATION Sick Total Disapproval due to Vacation Sick Total Disapproval due to

DULCE AMOR L. BARCENA MIGUEL D. TOLENTINO, JR. DULCE AMOR L. BARCENA MIGUEL D. TOLENTINO, JR.
City Human Resource Management Officer Authorized Official City Human Resource Management Officer Authorized Official

7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO: 7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:

X day/s with pay X day/s with pay


days without pay days without pay
others (specify) others (specify)

ATTY. HENRY R. ROSANTINA ATTY. HENRY R. ROSANTINA


Executive Assistant V Executive Assistant V
Office of the City Administrator for Personnel Matters Office of the City Administrator for Personnel Matters
Date: Date:

1. Application for vacation or sick leave for one full day or more months shall be made this form and to be accomplished in duplicate. 1. Application for vacation or sick leave for one full day or more months shall be made this form and to be accomplished in duplicate.
2. Application for vacation leave shall be filed in advance or whatever possible five (5) days before going on such leave. 2. Application for vacation leave shall be filed in advance or whatever possible five (5) days before going on such leave.
3. Application for sick leave in advance, or exceeding five (5) days shall be accomplished by a Medical Certificate. In due of Medical 3. Application for sick leave in advance, or exceeding five (5) days shall be accomplished by a Medical Certificate. In due of Medical
Consultation was not availed of, affidavit should be executed by an applicant. Consultation was not availed of, affidavit should be executed by an applicant.
4. Clearance from the Head of Office will be submitted for 30 days vacation leave. 4. Clearance from the Head of Office will be submitted for 30 days vacation leave.
leave form leave form

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