APPLICATION FOR LEAVE

CSC Form No. : 6

REVISED 1984 BALBAS JULIUS HARVEY PRIETO
1. OFFICE/AGENCY :2. NAME (LAST) (FIRST) (MIDDLE)
COMMISSION ON ELECTIONS :

3. DATE OF FILING : 4. DESIGNATION 5: SALARY (Monthly)

APRIL 25, 2017 ELECTION OFFICER III__ P_36, 960____
6. DETAILS OF APPLICATION
(a) TYPE OF LEAVE (b) WHERE LEAVE WILL BE SPENT
(1) IN CASE OF VACATION LEAVE

Vacation

To seek employment___________________ _____ Within the Philippines

Others (Specify)
_____ Abroad (Specify):

(2) IN CASE OF SICK LEAVE

Sick _____ In Hospital (Specify) ___________________________

____________________________________________
Maternity

Others (Specify) ___________________ _____ Out-Patient(Specify):Body Pain and Severe Colds

________________________________ ________________________________________

(c) NUMBER OF WORKING DAYS (d) COMMUTATION

APPLIED FOR
_____Requested _____Not Requested
INCLUSIVE DATES: July 26, 2017

________________________________
(Signature of Applicants)

7. DETAILS OF ACTION ON APPLICANT

(a) RECOMMENDATION(*) (b) CERTIFICATION OF LEAVE CREDITS
AS OF _________________________
____________________________________________
Approval : Vacation : Sick : Total :
:_____________ :_________________:_________________:
: : : :
: : : :
: : : :
: Days : Days : Days
Disapproval due to ___________________ _________________________________________________

ATTY. ALIPIO ALONZO S. CASTILLO III

(Authorized Officials)
(c) APPROVED FOR :
__________ Days with pay
__________ Days without pay
__________ Others (Specify)
(Personnel Manager)
DISAPPROVED DUE TO:
__________________________________________
__________________________________________
__________________________________________

(Executive Director / Asst. Exec. Director for Administration or Operations)

DATE : ______________________________________

(*) Recommendation for approval or disapproval shall be signed by the head of the office or department in which the
applicant for leave is holding office. For field personnel, the Election Registrar shall sign in case of Election Clerk; the
PES in case of Election Registrar and staff of the PES; and the Regional director in case if PES and staff REDO.