Republic of the Philippines

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES

Visayas Avenue, Diliman, Quezon City

A P P L I C A T I O N F O R L E A V E
1 ___________________________ 2. _______________________ _____________ ____________
OFFICE/AGENCY Name ( Last ) ( First ) ( Middle )

3 4 5
Date of Filing Position Salary (Monthly)

DETAILS OF APPLICATION

6. a. Type of Leave b. Where Leave will be spent:

Vacation (1) In case of Vacation Leave

To seek employment Within the Philippines
Sick Abroad(Specify)
Maternity
Others (Specify) (2) In case of Sick Leave
In Hospital (Specify)

Out Patient (specify)

c. Number of Working Days d. Commutation:

Applied for: _______________________________ Requested
Inclusive Dates:____________________________ Not Requested

(Signature of Applicant)

DETAILS OF APPLICATION
7. a. Certification of Leave Credits b. Recommendation
as of Approval
Disapproved due to _______
Vacation Sick Total

days days days

___________________________ _________________________
HRM Officer (Authorized Official)
c. APPROVED FOR: d. DISAPPROVED FOR:
_____ Days with pay ___________________________________________
_____ Days without pay ___________________________________________
_____ Others ( specify )

__________________________________________
( Signature )

__________________________________________
( Authorized Official )