APPLICATION FOR LEAVE

LGU-NAGUILIAN PATACSIL JEFFREY C.

1. OFFICE/AGENCY 2. NAME (LAST) (FIRST) (M.I)

December 11, 2018 Legal Aide Php 387.73/day

3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY

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

VACATION (1) IN CASE OF VACATION LEAVE

Forced Leave
To seek employment ______ within the Philippines
Others ______ Abroad

Ö SICK (2) IN CASE OF SICK LEAVE

_____ Maternity
Ö Others (Influenza)

6. c) NUMBER OF WORKING DAYS 6. d) COMMUTATION

Applied for 1 ______ requested
Effectivity December 10, 2018 ______ not requested

SIGNATURE OF APPLICANT

DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION

As of _____ Approval
____________________________ _____ Disapproval due to

VACATION SICK TOTAL

DAYS DAYS DAYS

ATTY. DEARKYLE ANICEE A. GALVEZ-TAQUED
Name of Authorized Official

Secretary to the Sanggunian

Official Designation

JESISCA B. RIMANDO-HIPOL
Human Resource Management Officer II

7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:

_________ days with pay
_________ days without pay
_________ others (specify)

REYNALDO J. FLORES
Name and Signature of Authorized Official
Mayor