7/17/2019 Application for Leave of FO Staff

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CSC Form No. 6

Revised 1984

APPLICATION FOR LEAVE

1. OFFICE/AGENCY 2. NAME (Ls!" (Firs!" (Midd#e"

  Parole and Probation Administration

$. %A&E OF FILING 4. 'OSI&ION . SALARY (Mo)!*#+"

DETAILS OF APPLICATION

6. ." &Y'E OF LEA,E 6. -." ERE LEA,E ILL 0E S'EN&

&ermi)# Leve

,!io) (1" IN CASE OF ,ACA&ION LEA,E

&o see3 em#o+me)! i!*i) !*e '*i#ii)es

O!*ers (Sei5+" A-rod (Sei5+"  

Si3 (2" IN CASE OF SIC7 LEA,E

M!er)i!+ I) osi!# (sei5+"  

O!*ers (Sei5+"  

." NM0ER OF OR7ING %AYS A''LIE% d." COMM&A&ION

  FOR Re:es!ed No! re:es!ed

INCLSI,E %A&ES  

(Si;)!:re o5 A#i)!"

DETAILS OF ACTION ON APPLICATION

<. ." CER&IFICA&ION OF LEA,E CRE%I&S <. -." RECOMMEN%A&ION

s o5  

 Arov#

,!io) Si3 &o!#

%isrov# d:e !o  

%+s %+s %+s

 AOIV MARIA THERESA L. MANZANO

('erso))e# O55ier" C*ie5 'ro-!io) )d 'ro#e O55ier  

<. ." A''RO,E% FOR <. d" %ISA''RO,E% %E &O

d+s =i!* +

d+s =i!*o:! +

o!*ers (sei5+"

(Si;)!:re"

RD MARISSA DC. AL!ETRA

(A:!*ori>ed O55ii#"

7/17/2019 Application for Leave of FO Staff

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