Republic of the Philippines

Department of Justice
Bureau of Corrections
LEYTE REGIONAL PRISON
Abuyog, Leyte

APPLICATION FOR LEAVE

CSC FORM No. 6
Revised 1984
__________________________________________________________________________________________________
OFFICE/AGENCY NAME (Last) (First) (M.I.)
BUREAU OF CORRECTIONS
__________________________________________________________________________________________________
DATE OF FILING POSITION SALARY (Monthly)

DETAILS OF APPLICATION
TYPE OF LEAVE 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)
___________________________
NO. OF WORKING DAYS APPLIED
For: ________________________________________ COMMUTATION
Inclusive Date _______________________________ ( ) Requested
( ) Not requested
__________________
Signature of Applicant
_________________________________________________________________________________________________
CERTIFICATION OF LEAVE CREDITS RECOMMENDATION
As of _________________________________________ ( ) Approved
Vacation Sick Total ( ) Disapproved due to _____________
______________________________________________ ________________________________
Days Days Days

PIS GERALDO I. ARO

ACTING- SUPERINTENDENT
MARY JANE N. JULIO
Acting Chief HRD Section

APPROVED FOR: DISAPPROVED DUE TO:

______________Days w/ pay _______________________
______________Days w/out pay ________________________
______________Others

REY M. RAAGAS
CHIEF ADMINISTRATIVE OFFICER
ADMINISTRATIVE DIVISION