Professional Regulation Commission

APPLICATION FOR LEAVE

C.S. Form No. 6

1. OFFICE/DIVISION/SECTION 3. NAME (Last) (First) (Middle)

PRC-RO1/LEGAL SALLY FERDINAND TEJERO

2. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

JANUARY 31, 2019 ATTORNEY IV 75,359.00

DETAILS OF APPLICATION

6. A) TYPE OF LEAVE 6. B) WHERE LEAVE WILL BE SPENT

Vacation IN CASE OF VACATION LEAVE
To seek employment Within the Philippines
Other (Specify) _______________ Abroad (Specify) ____________________
Sick
/ Maternity (Specify) _______________ IN CASE OF SICK LEAVE
Others (Specify) ______________ In Hospital (Specify)__________________
/ Out Patient (Specify) _________________

6. C) NUMBER OF WORKING DAYS APPLIED FOR

__4 days______ 6. D) COMMUTATION
Requested Not Requested
INCLUSIVE DATES: February 6,7,14,24, 2020_

___________________
Signature of Employee

DETAILS OF ACTION ON APPLICATION

7. A) CERTIFICATION OF LEAVE CREDITS 7. B) RECOMMENDATION

As of ___________________________
APPROVAL

VACATION SICK TOTAL DISAPPROVAL DUE TO_________________

______________________________________
____

less this
leave:

BALANCE
VIRGINIA N. MARTIN
Certified Correct: Officer-In-Charge

JILL ROSE S. PEREZ

Recommending Approval:

MARIE GRACE P. NAVA

SAO, FAD

7. C) APPROVED FOR: 7. D) DISAPPROVAL DUE TO:

_____________________ Days with pay _____________________

_____________________ Days without pay _____________________
_____________________ Others (Specify)
HRMD-AM-02
Rev. 00
February 25, 2015
Page 1 of 2
 VIRGINIA N. MARTIN
Officer-In-Charge

(SEE INSTRUCTIONS AT THE BACK)

INSTRUCTIONS

1. Application for vacation or sick leave for one full day or more shall be made
on this form and shall be accomplished at least in duplicate.

2. Application for sick leave of absence for one full day or more shall be filed
immediately upon the employee’s return from such leave.

3. Application for vacation leave shall be filed in advance or whenever

possible five (5) days before going on such leave.

4. Application for sick leave filed in advance, or exceeding five (5) days shall be
accompanied by a medical certificate (CS Form No. 41). In case medical
consultation was not availed of, an affidavit should be executed by the
applicant.

5. An employee who is absent without approved leave shall not be entitled to

receive his salary corresponding to the period of his unauthorized leave of
absence.

6. An application for leave of absence for thirty (30) calendar days or more shall
be accompanied by a clearance from money and property accountabilities.

October 15, 1984

CSC

HRMD-AM-02
Rev. 00
February 25, 2015
Page 2 of 2