APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

HOUSING AND LAND USE REGULATORY BOARD
3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

DETAILS 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) _____________ Abroad (Specify) __________________

___________________________ _________________________________

x Sick 2. IN CASE OF SICK LEAVE

Maternity In Hospital (Specify) ________________

_________________________________
Others (Specify) _____________________
___________________________________ Out Patient (Specify) ________________
_________________________________
6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION
FOR _______________________________
Requested Not requested
INCLUSIVE DATES _______________________
________________________
(Signature of Applicant)

DETAILS OF ACTION OF APPLICATION

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

as of _______________________________
Approval
Vacation Sick Total
Disapproval due to ___________________
___________________________________

RUNEL B. TANINGCO
Days Days Days ____________________
Supervisor
LINDA L. MALENAB-HORNILLA
________________________________ ____________________________
(Personnel Officer) .Regional Officer

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

_______________________________________
________________ days with pay _______________________________________
________________ days without pay
________________ others (Specify)

_________________________
(Signature)

_________________________________
(Authorized Official)
DATE: _____________

HLURB Ver. 01