CSC Form No.

6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
March 20, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

6. a) TYPE OF LEAVE 6. b) WHERE LEAVE 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)
[ X ] Others (specify)
Due to stomach ache [ X ] Out Patient (specify)
Rested at home

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

One (1) day [ ] Requested
INCLUSIVE DATES [ ] Not Requested
March 19, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)
 MARY JOYCE G. ERUMA
Regional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
March 27, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

6. a) TYPE OF LEAVE 6. b) WHERE LEAVE 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)
[ X ] Others (specify)
Due to Allergy [ X ] Out Patient (specify)
Rested at home

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

One (1) day [ ] Requested
INCLUSIVE DATES [ ] Not Requested
March 26, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)

MARY JOYCE G. ERUMA

Regional Supervising Auditor
PPLICATION FOR LEAVE

MIDDLE
DELA CRUZ
5. MONTHLY SALARY
P34,231
ETAILS OF APPLICATION

Rested at home

S OF ACTION ON APPLICATION

ARY JOYCE G. ERUMA

gional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
April 6, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

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

[ X ] Vacation 1. IN CASE OF VACATION LEAVE

[ ] To seek employment [ X ] Within the Philippines
Others (specify) [ ] Abroad (specify)
Birthday Leave

[ ] Sick 2. IN CASE OF SICK LEAVE

[ ] Maternity [ ] In hospital (specify)
[ ] Others (specify)
[ ] Out Patient (specify)

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

One (1) day [ ] Requested
INCLUSIVE DATES [ ] Not Requested
April 17, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)
 MARY JOYCE G. ERUMA
Regional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
April 6, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

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

[ X ] Vacation 1. IN CASE OF VACATION LEAVE

[ ] To seek employment [ X ] Within the Philippines
Others (specify) [ ] Abroad (specify)
Force Leave; Birthday Leave;
Special Leave
To attend to some Bar Matters
at SC, Manila

[ ] Sick 2. IN CASE OF SICK LEAVE

[ ] Maternity [ ] In hospital (specify)
[ ] Others (specify)
[ ] Out Patient (specify)

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

Nine (9) days [ ] Requested
INCLUSIVE DATES [ ] Not Requested
Birthday Leave: April 17, 2015
Force Leave: April 20-24, 2015
Special Leave: April 27, 2015
Vacation Leave: April 28 - 29, 2015
EMILIA CONCEPCION D. SEVERINO
Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)

MARY JOYCE G. ERUMA

Regional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
April 6, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

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

[ X ] Vacation 1. IN CASE OF VACATION LEAVE

[ ] To seek employment [ X ] Within the Philippines
Others (specify) [ ] Abroad (specify)
Force Leave
To attend to some Bar
Matters at SC Manila

[ ] Sick 2. IN CASE OF SICK LEAVE

[ ] Maternity [ ] In hospital (specify)
[ ] Others (specify)
[ ] Out Patient (specify)

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

Five (5) days [ ] Requested
INCLUSIVE DATES [ ] Not Requested

April 20-24, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)

MARY JOYCE G. ERUMA

Regional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
April 6, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

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

[ X ] Vacation 1. IN CASE OF VACATION LEAVE

[ ] To seek employment [ X ] Within the Philippines
Others (specify) [ ] Abroad (specify)
Special Leave
To attend to some
Matters at IBP

[ ] Sick 2. IN CASE OF SICK LEAVE

[ ] Maternity [ ] In hospital (specify)
[ ] Others (specify)
[ ] Out Patient (specify)

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

One (1) day [ ] Requested
INCLUSIVE DATES [ ] Not Requested

April 27, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)

MARY JOYCE G. ERUMA

Regional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
July 29, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

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

[ ] Vacation 1. IN CASE OF VACATION LEAVE

[] To seek employment [ ] Within the Philippines
[ X ] Others (specify) [ ] Abroad (specify)
Special Leave Privilege
(Optional Retirement - Milestone)

[ ] Sick 2. IN CASE OF SICK LEAVE

[ ] Maternity [ ] In hospital (specify)
[ ] Others (specify)
[ ] Out Patient (specify)

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

One (1) day [ ] Requested
INCLUSIVE DATES [ ] Not Requested

July 31, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)

MARY JOYCE G. ERUMA

Regional Supervising Auditor
CSC Form No. 6
REVISED 1984
APPLICATION FOR LEAVE

1. OFFICE AGENCY EMPLOYEE NO. 2. NAME (LAST) FIRST MIDDLE

COA-CGS B & C LBP-PPC 0216518 SEVERINO EMILIA DELA CRUZ
3. DATE OF FILING 4. POSITION 5. MONTHLY SALARY
May 20, 2015 STATE AUDITOR II P34,231
DETAILS OF APPLICATION

6. a) TYPE OF LEAVE 6. b) WHERE LEAVE 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)
[ X ] Others (specify)
Due to allergies [ X ] Out Patient (specify)
Rested at home

c) NUMBER OF WORKING DAYS APPLIED d) COMMUTATION

One (1) day [ ] Requested
INCLUSIVE DATES [ ] Not Requested

May 19, 2015

EMILIA CONCEPCION D. SEVERINO

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

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

AS OF
[ ] Approved
VACATION SICK TOTAL [ ] Disapproved due to

MARK G. RODRIGUEZ
Personnel Officer Audit Team Leader

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

days with pay
days without pay
Others (specify)

MARY JOYCE G. ERUMA

Regional Supervising Auditor