Application for Leave 2 - Free Download
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CSC Form No. _______
Revised 1984
APPLICATION FOR LEAVE
1. OFFICE/AGENCY
2. a) NAME (Last) (First) (Middle)
2. b) EMPLOYEE NO.
3. DATE OF FILING
M M D D Y Y Y Y
4. POSITION
5. SALARY(Monthly)
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE
Vacation
Others (specify)______________________
___________________________________
Sick
Maternity
Paternity
6. c) NUMBER OF WORKING DAYS
APPLIED FOR ____________________
INCLUSIVE DATES:
FROM TO
MM DD YYYY MM DD YYYY
6. b) WHERE LEAVE WILL BE SPENT
1. IN CASE OF VACATION LEAVE
Within the Philippines
Abroad (specify) ____________________
2. IN CASE OF SICK LEAVE
In Hospital (Specify) _________________
Out Patient (Specify) _________________
6. d) COMMUTATION
Requested
Not Requested
______________________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION OF LEAVE
As of ______________________
VACATION SICK TOTAL
______________________________
Personnel Officer
7
. b) RECOMMENDATION
Approved
Disapproved due to ____________________
____________________________________
______________________________
Authorized Official
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:
days with pay
days without pay
others (specify)
_________________________________
Authorized Official
