APPLICATION FOR LEAVE

CSC FORM No. 6 DATE OF APPLICATION: ________ _

Revised 1984 CONTROL NUMBER:______________
1. OFFICE 2. NAME (LAST) (FIRST) (MIDDLE)
4th Mobile Company, RPSB-NCRPO
3. RANK 4. DATE OF OATHTAKING DATE ASSIGNED TO RMG 5. SALARY

(DETAILS OF APPLICATION)

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

(1) IN CASE OF VACATION LEAVE
Vacation
_________ To seek employment X Within the Philippines
____ ____ Others (Specify) ___________ ________ Abroad (Specify) _______________

_________ Sick
_________ Maternity (2) IN CASE OF SICK LEAVE
_________ Others (Specify) In Hospital (Specify)
___________ _____________________ _______________________________
Out Patient (Specify)

6c) NUMBER OF WORKING DAYS APPLIED FOR 6d) COMMUTATION

Inclusive Dates Request/Not Requested

___________________________
Signature of Applicant
And

_______________________________
Address while on leave/Tel No. /CP No

DETAILS OF ACTION APPLICATION

7a) CERTIFICATION OF LEAVE CREDITS 7b) RECOMMENDATION

as of _____________________
Approval
Disapproved due to
_____________________________________
Vacation Sick Total

PCI CHARLIE D. UMAYAM

C, 4th MCRPSB-NCRPO
(Authorized Official)
______________________________________
(Personnel Officer)

APPROVED FOR: DISAPPROVED DUE TO:

________________ Days with Pay ____________________________________

________________ Days without Pay ____________________________________
________________ Others (Specify) ____________________________________

_________________________________
(Signature)

__________________________________
(Authorized Official)

DATE: ____________________