APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984
PNP RIAS5 SPO2 Cruz, Ulyses Janaban
1. OFFICE/AGENCY 2. NAME (LAST) FIRST MIDDLE

October 23, 2018 IAD PNCO Perm 34, 079.00

3. DATE OF FILING 4. POSITION (STATUS OF APPTMNT) 5. SALARY

(DETAIL OF APPLICATION)

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

[ ] VACATION 1. IN CASE OF VACATION LEAVE
[ ] TO SEEK EMPLOYMENT [ / ] WITHIN THE PHILIPPINES
[ ] OTHERS (SPECIFY) Mandatory Leave [ ] ABROAD (SPECIFY)____

[/] SICK 2. IN CASE OF SICK LEAVE

In Hospital (Specify)
[ ] MATERNITY/PATERNITY
________________________________
[/ ] OTHERS (SPECIFY) Privilege leave (OUT PATIENT) SPECIFY

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

APPLIED FOR:
_____ __3 days_ ________
[ ] Requested [ ] Not Requested
Inclusive Date:

_Novemebr 26-28, 2018

Signature of Applicant
And Address
600 Barlin St., Sampaloc, Sorsogon City

DETAILS OF ACTION APPLICATION

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

as of _____________________________ [ ] Approval
[ ] Disapproval due to_______
______________________
VACATION SICK TOTAL

PINSP ELISEO L BERCASIO

OIC, AFMD, RIAS5
(Personnel Officer)

============================================================================

APPROVED FOR DISAPPROVED DUE TO

______________ Days with pay ________________________
______________ Days without pay ________________________
______________ Others (Specify) ________________________

LEO ANGELO D. LEUTERIO

POLICE DIRECTOR
Deputy Inspector General, IAS
(Authorized Official)