CS Form No.

6
Revised 1984

APPLICATION FOR LEAVE

1. OFFICE/AGENCY 2. NAME (Last) First Middle

RTC-BRANCH 6, MLA. ABRENICA ROSETTE HERNANDEZ

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

April 11, 2019 Branch Clerk of Court

DETAILS OF APPLICATION
6.1 TYPE OF LEAVE 6.2 WHERE LEAVE WILL BE SENT
[ ] Vacation IN CASE OF VACATION LEAVE
[ ] To seek employment [ ] Within the Philippines
[ ] Others (Specify) ( ) [ ] Abroad (Specify)

[x] Sick IN CASE OF SICK LEAVE

[ ] Maternity [ ] In Hospital (Specify) ___________
[ ] Others (Specify) [ ] Out-Patient (Specify)

6.3 NUMBER OF WORKING DAYS APPLIED FOR 6.4 COMMUTATION

ONE (1) day [ ] Requested [ ] Not Requested
INCLUSIVE DATES
March 8, 2019
(Signature of Applicant)
For Court Personnel

DETAILS OF ACTION ON APPLICATION

(To be filled-up by the Employees’ Leave Division)

7.1 CERTIFICATION OF LEAVE CREDITS 7.2 RECOMMENDATION

As of _______________________________

[ ] Approval
Vacation Sick Total
[ ] Disapproval

Days Days Days

JASON J. ZAPANTA
(Personnel Officer) (Acting Presiding Judge)

7.3 APPROVED FOR: 7.4 DISAPPROVED DUE TO:

____________ days with pay
____________ days without pay
____________ Others (Specify)

(Signature)

HON. VIRGILIO V. MACARAIG

(Executive Judge)