Form6hs (Forelem)

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CS FORM 6

Revised 1984
APPLICATION FOR LEAVE
1. AGENCY : 2. NAME (LAST) (FIRST) (MI)

DATE OF FILING : 4. POSITION : 5. SALARY (Monthly)


__________________________________________________________________________________________

__________________________________DETAILS OF
APPLICATION_______________________________
6.a)TYPE OF LEAVE 6.b) Where leave will be spent?
1. IN CASE OF VACATION LEAVE

_________________ Vacation : _______________With in the Philippines


/________________/ : /______________/
_________________To seek employment : _______________ Abroad (Specify)
/________________/ Others (specify) : /______________/
_________________ : 2. IN CASE OF SICK LEAVE
/________________/ : _______________ In Hospital (Specify)
: /______________/
: _______________ Out-Patient (Specify)
: /______________/
NUMBER OF WORKING DAYS APPLIED : 6. d-COMMUTATION
For _______________ : _______________ Requested
INCLUSIVE DATES __________________ : /______________/
__________________ : _______________ Not Requested
: /______________/

: _________________________
__________________________________________:_____________________Signature of Applicant________
________________________DETAILS OF ACTION ON APPLICATION_____________________________
CERTIFICATION OF LEAVE CREDITS : 7. b-RECOMMENDATION
As of ________________ : _____________________ Approved
_______________________________________ : /____________________/
Vacation : Sick : Total : _____________________ Disapproval due to
_______________________________________ : /____________________/
Days : Days : Days :
:
_______________________________________ :
_________________________
: Authorized Official
__________________________________________:
_____________(Personnel Officer)_____________________________________________________________
APPROVED FOR : 7. d-DISAPPROVED DUE TO

__________________ Days with Pay : ___________________________


__________________ Days without : ___________________________
__________________ Other (Specify) :

_____________________________
Signature

_____________________________
Authorized Official

NOTE:__________________________

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