APPLICATION FOR LEAVE FORM

Barangay Name (Last) (First) (Middle)

Awi Nieva Melanie Lopez
Date of Filing Position Honorarium (monthly)
February 15, 2022 Barangay Treasurer P 9,600
DETAILS OF APPLICATION

TYPE OF LEAVE WHERE LEAVE WILL BE SPENT

_____ VACATION LEAVE IN CASE OF VACATION LEAVE
_____ SICK
_______ To seek Employment _____ Within the Philippines
_______ Others (specify) _______ Abroad (specify)

NUMBER OF WORKING DAYS APPLIED IN CASE OF SICK LEAVE

__3__ working days ____ In hospital (specify) at home.
_______________________________________ ______________________________________
_ ___

INCLUSIVE DATES _______ Out Patient

February 16-18, 2022
_______________________________________ (specify)____________
___ ______________________________________
_______________________________________ ___
___
COMMUTATION

_______ Requested _______ Not

Requested

_______________________
Signature of Applicant
DETAILS OF ACTION OF APPLICATION

CERTIFICATION OF LEAVE CREDIT RECOMMENDATION

As of _______ Approval
_____________________________________ _______ Disapproval due to
_____________
Vacation Sick Total
________ ________ ________ _____________________________

KHRISTINA D. DEL VALLE _____________________________

Barangay Secretary
PAZ M. PACAO
Punong Barangay
 APPLICATION FOR LEAVE FORM

Barangay Name (Last) (First) (Middle)

Awitan Reynaldo Myrna Guevarra
Date of Filing Position Honorarium (monthly)
July 5, 2022 Barangay Health Worker P 1,100.00
DETAILS OF APPLICATION

TYPE OF LEAVE WHERE LEAVE WILL BE SPENT

____
 VACATION LEAVE IN CASE OF VACATION LEAVE
_____ To seek Employment
_____ Sick Leave _______ Within the Philippines
_____ Others (specify) _______ Abroad (specify)

IN CASE OF SICK LEAVE

NUMBER OF WORKING DAYS APPLIED ______ At home.
6 working days ____________________________________
_______________________________________
_______ Out Patient
INCLUSIVE DATES (specify)____________
__________________________________________ ____________________________________
_______________________________________
COMMUTATION

_______ Requested _______ Not

Requested

_______________________
Signature of Applicant
DETAILS OF ACTION OF APPLICATION

CERTIFICATION OF LEAVE CREDIT RECOMMENDATIONS

As of _______ Approval
_____________________________________ _______ Disapproval due to
_____________
Vacation Sick Total
________ ________ ________ _____________________________

Jackie C. Pasatiempo _____________________________

Barangay Secretary
MELIANDRO A. EBOÑA
Punong Barangay

APPROVED FOR DISAPPROVED DUE TO:

_______ days with pay __________________________________

_______ days without pay __________________________________
_______ others (specify) __________________________________
MELIANDRO A. EBOÑA
Punong Barangay