CS Form No.

9
Revised 1994

_________________________

APPLICATION FOR LEAVE

1.

OFFICE/ AGENCY

3.

DATE OF FILING

2.
4.

NAME (LAST)
POSITION

6A. TYPE OF LEAVE

(Signature)

(FIRST)
5.

_________________________

(MIDDLE)
SALARY (MONTHLY)

(Authorized Official)

DETAILS OF APPLICATION
6B. WHERE LEAVE WILL BE SPENT
(1) IN CASE OF VACATION LEAVE

Vacation
To seek employment
Others (Specify)
Sick
Maternity
Others (Specify)
6C. NUMBER OF WORKING DAYS APPLIED
FOR ______________________
INCLUSIVE DATES : ___________________

Within the Philippines

Abroad (Specify)
(2) IN CASE OF SICK LEAVE
In Hospital (Specify) _____________
Out Patient (Specify) _____________
6D. COMMUTATION
Requested
Not Requested

CS Form No. 9
Revised 1994

APPLICATION FOR LEAVE

1.
3.

OFFICE/ AGENCY
DATE OF FILING

6A. TYPE OF LEAVE

___________________

2.
4.

NAME (LAST)
POSITION

AS OF _______________________
VACATION
SICK
TOTAL

_______________________

Approval ______________________
Disapproved due to ______________
______________________________
______________________________

5.

(MIDDLE)
SALARY (MONTHLY)

DETAILS OF APPLICATION
6B. WHERE LEAVE WILL BE SPENT
(1) IN CASE OF VACATION LEAVE

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7A. CERTIFICATION OF LEAVE CREDITS
7B. RECOMMENDATION

(FIRST)

Vacation
To seek employment
Others (Specify)
Sick
Maternity
Others (Specify)
6C. NUMBER OF WORKING DAYS APPLIED
FOR ______________________
INCLUSIVE DATES : ___________________

Within the Philippines

Abroad (Specify)
(2) IN CASE OF SICK LEAVE
In Hospital (Specify) _____________
Out Patient (Specify) _____________
6D. COMMUTATION
Requested
Not Requested

_________________________
(Authorized

___________________

Representative)

Signature of Applicant
7C. APPROVED FOR:
______________ days with pay
______________ days without pay
______________ others (specify)

7D. DISAPPROVED DUE TO:

____________________________________
____________________________________
____________________________________

DETAILS OF ACTION ON APPLICATION

7A. CERTIFICATION OF LEAVE CREDITS
7B. RECOMMENDATION
AS OF _______________________
VACATION
SICK
TOTAL

Approval ______________________
Disapproved due to ______________

______________________________
______________________________

_______________________

_________________________
(Authorized
Representative)

7C. APPROVED FOR:

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

7D. DISAPPROVED DUE TO:

____________________________________
____________________________________
____________________________________

_________________________
(Signature)
__________________________
(Authorized Official)