APPLICATION FOR LEAVE

CSC FORM NO. 6 REVISED 1984

1. Office / Agency 2. Name (Last) (First) (Middle)
BOI Osingat Efraim Cabato
3. Date of Filing 4. Position 5. Salary (Monthly)
Accountant III SG 19
Dec 10, 2018
6. DETAILS OF APPLICATION
6.a) TYPE OF APPLICATION 6.b) WHERE LEAVE WILL BE SPENT:
(1)
Vacation IN CASE OF VACATION LEAVE

To seek employment Within the Philippines

Others (Specify) Abroad (Specify) ______________________________


Sick (2) IN CASE OF SICK LEAVE

Maternity In Hospital (Specify) _____________________

Other (Specify) Out Patient (Specify)

______________________________________

6.c) NUMBER OF WORKING DAYS APPLIED FOR: 6.d) COMMUTATION

INCLUSIVE DATES  Requested Not Requested

(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

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

as of ___________________________
Vacation Sick Total Approval _________________________________

Disapproval _______________________________
Days Days Days

MA. ROLIENITA D. NEBRES

Chief Admin. Officer / HRDD (Signature of Immediate Supervisor)

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

__________________ days with pay
__________________ days without pay ________________________
__________________ Others (Specify) ________________________
 Director
Signature /Head of Department/Unit
Date: ________________

INSTRUCTIONS
1. Application for vacation or sick leave for one full day or more shall be made on this form and to be accomplished at least in duplicate.
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going on such leave.
3. Application for a sick leave filed in advance, or exceeding five (5) days shall be supported by medical certificate. In case medical
consultation was not availed of, an affidavit should be executed by the applicant.
4. An application for leave of absence for thirty (30) days or more shall be accompanied by clearance from money and property
accountabilities.