CSC FORM NO. 6Revised 1984 APPLICATION FOR LEAVE

1. OFFICE/AGENCY

3. DATE OF FILING

2. NAME (Last) (First) (Middle Name)

4. POSITION 5. SALARY (Monthly)

6. DETAILS OF APPLICATION

6.a) TYPE OF LEAVE

Vacation

To seek employment

Others (Specity)

Sick

Maternity

Others (Specity)

6.c) NUMBER OF WORKING DAYS APPLIED ( )

INCLUSIVE DATES:

6. b) WHERE LEAVE WILL BE SPENT

(1) IN CASE OF VACATION LEAVE

Within the Philippines

Abroad (Specify)(2) IN CASE OF SICK LEAVE

In Hospital (Specify)

Out Patient (Specify)

6. d) COMMUTATION

Requested Not Requested

(Signature of Applicant)

7. DETAILS OF APPLICATIONACTION ON

7.b) RECOMMENDATION

Approval

Disapproval due to

(Authorized Official)

7.c) APPROVED FOR:

Days with pay

Days without pay

Others (Specify)

Date :

RONNEL C. RIVERACity Mayor

7.d) DISAPPROVED DUE TO:

By the Authority of the City Mayor:

Gabriel Francis Glenville N. GonzalezAsst. City Administrator-Administration

CMO-ICTD NARIDO MARK JUNNIES GAHOB

VACATION SICK TOTAL

LEAH Y. TOLIMAO CGDH II

7.a) CERTIFICATION OF LEAVE CREDITSAs of

CSC FORM NO. 6Revised 1984 APPLICATION FOR LEAVE

1. OFFICE/AGENCY

3. DATE OF FILING

2. NAME (Last) (First) (Middle Name)

4. POSITION 5. SALARY (Monthly)

6. DETAILS OF APPLICATION

6.a) TYPE OF LEAVE

Vacation

To seek employment

Others (Specity)

Sick

Maternity

Others (Specity)

6.c) NUMBER OF WORKING DAYS APPLIED ( )

INCLUSIVE DATES:

6. b) WHERE LEAVE WILL BE SPENT

(1) IN CASE OF VACATION LEAVE

Within the Philippines

Abroad (Specify)(2) IN CASE OF SICK LEAVE

In Hospital (Specify)

Out Patient (Specify)

6. d) COMMUTATION

Requested Not Requested

(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.b) RECOMMENDATION

Approval

Disapproval due to

(Authorized Official)

7.c) APPROVED FOR:

Days with pay

Days without pay

Others (Specify)

Date :

RONNEL C. RIVERACity Mayor

7.d) DISAPPROVED DUE TO:

By the Authority of the City Mayor:

Gabriel Francis Glenville N. GonzalezAsst. City Administrator-Administration

CMO-ICTD NARIDO MARK JUNNIES GAHOB

VACATION SICK TOTAL

LEAH Y. TOLIMAO CGDH II

7.a) CERTIFICATION OF LEAVE CREDITSAs of

1 Day 1 Day

1 Day 1 Day

July 07, 2015

07/07/2015 DATA CONTROLLER II 14, 939.00

07/07/2015 DATA CONTROLLER II 14, 939.00

July 07, 2015

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