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CS Form No.

6
Revised 1983

APPLICATION FOR LEAVE


1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)
Engineering Office Plaga Junar G.
3. DATE OF FILING 4. POSITION 5. SALARY(MONTHLY)
December 18, 2017 Engineer I 17,110.00
DETAILS OF APPLICATION

6. a) TYPE OF LEAVE 6. b) Where leave will be spent?


[ ] VACATION 1. In case of Vacation Leave
[ ] To seek employment [ ] Within the Philippines
[ ] Others (specify) [ ] Abroad (specify) ___________
[ ] SICK 2. In case of Sick Leave
[ ] Maternity [ ] In hospital (specify)_________
[x] Others [ ] Outpatient specify)_________
c) COMMUTATION
NO. OF DAYS APPLIED FOR: [ ] Requested
three (3) days [ ] Not Requested

INCLUSIVE DATES
December 27-29, 2017
Junar G. Plaga
Signature of Applicant
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~
DETAILS OF ACTION ON APPLICATION

7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION


as of ___________________________ [ ] Approval
_______________________________ [ ] Disapproval due to ________
Vacation Sick Total ___________________________

_______________________________
Days Days Days ENGR. MAURICIO L. TOMARONG
(Authorized Official)

ROMELA Q. SAJONIA
HRMO-IV
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
8. a) APPROVED FOR: b) DISAPPROVED DUE TO:

____________________ days with pay _____________________


____________________ days without pay
____________________ others (specify)

HON. EDGAR S. LIGNES


City Mayor
(Authorized Official)

________________
Date

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