APPLICATION FOR LEAVE

1. OFFICE/AGENCY

2. NAME

MTCC, Branch 1, Iloilo City

3. DATE OF FILING
April 30, 2012

(Last)

(First)

GUATH

(Middle)

MARY GRACE

4. POSITION
Legal Researcher 1

TARUC

5. SALARY (Monthly)
Php18,333.00

DETAILS OF APPLICATION
6. a) TYPE OF LEAVE

6. b) WHERE LEAVE WILL BE SPENT

1. In case of Vacation Leave

Vacation

To seek employment
Others (Pls. specify)

Sick
Maternity/Paternity
Others (Pls. specify) _______________

Within the Philippines

Abroad (Pls. specify)

2. In case of Sick Leave

In Hospital (Pls. specify) ______

___________________________
Out-Patient (Pls. specify)
cough and fever

6. c) Number of Working Days Applied For:

6. d) Commutation

Three (3) days

Requested

Not Requested

April 25, 26 & 27, 2012

____________________________________

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. a) RECOMMENDATION

Approval

Disapproval due to ___________________

_______________________________________

_________________________________
MARCIANA Q. DEGUMA
PRESIDING JUDGE
x-----------------------------------------------------------------------------------------------------------------------------------------------------------x

DO NOT WRITE BELOW THIS LINE (To be filled up by Leave Division)

7. b) CERTIFICATION OF LEAVE CREDITS
As of : __________________________
(TENTATIVE)
VACATION

SICK

TOTAL

Days

Days

Days

____________________________________
(Personnel Officer)
7. c) APPROVED FOR:
_________ days vacation leave with pay
_________ days sick leave with pay
_________ days maternity/paternity leave with pay
_________ days special privilege leave with pay
_________ days forced leave with pay
_________ days Compensatory Time-Off (CTO)
_________ days ____________ LWOP

__________________________________________
Date:

7. d) DISAPPROVED DUE TO:

____________________________________
____________________________________
____________________________________

____________________________________
Signature

____________________________________
Authorized Official

-----------x