APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)
Rizal Medical Center PASATIEMPO, JOHN PAUL TALABONG
3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)
February 29, 2016 Administrative Assistant III
DETAILS OF APPLICATION
6.a) TYPE OF LEAVE 6.b) WHERE LEAVE WILL BE SPENT:
(1) IN CASE OF VACATION LEAVE
[ ] Vacation
[ ] To seek employment [X] Within the Philippines
[ ] Others Specify: [ ] Abroad (Specify) ____________________
____________________________________ _________________________________________
______________________________________
[ x] Sick (2) IN CASE OF SICK LEAVE
[ ] Maternity
[ ] Others Specify: [ ] In Hospital (Specify)________________
______________________________________
_______________________ ______________________________________
[ ] Out Patient (Specify) _______________
6.c) NO. OF WORKING DAYS APPLIED FOR: ______________________________________
4 days
INCLUSIVE DATES: _____________________________________
February 22, 23, 24, 26, 2016 6.d) COMMUTATION
[ ] Requested [ ] Not Requested

John Paul T. Pasatiempo

Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7.a) CERTIFICATION ON LEAVE CREDITS AS 7.b) RECOMMENDATION
OF: [ ] Approved
[ ] Disapproved due to ________________________
___________________________________ _________________________________________
____
VACATION SICK TOTAL
Ms. AIMEE KRISTEL R. LOPEZ, CPA
Accountant IV

Days Days Days

7.c) APPROVED FOR 7. d) Disapproved due to______________

___________________________________
_______________ days SL with pay
_______________ days VL with pay
_______________ days SL / VL without pay
_______________ others (specify)

___________________________________
(Signature)

____________________________________
(Authorized Signature)

Date:___________________