Republic of the Philippines

Province of Nueva Vizcaya

Municipality of Bambang

HUMAN RESOURCE MANAGEMENT OFFICE

Date of Filing: January 14, 2013

APPLICATION FOR LEAVE

No. _______________
1. OFFICE
SB OFFICE
2. DATE OF FILING
October 25, 2011

3. NAME(Last)
AMOGUIS
4. POSITION
Administrative Aide III

6. A. TYPE OF LEAVE
( ) Vacation
( ) To seek employment
( ) Others (specify)
___________________________________________
( x ) Sick
( ) Maternity/Paternity
( )Others(Specify)
________________
_______
C. NUMBER OF WORKING DAYS APPLIED FOR
____________________2 day
___
___________________________________________
Inclusive Days:
_______
January 16 17, 2013
_
_______________
________________

Vacation

Sick

FIRST
RICHARD
5. SALARY/MONTH

MIDDLE
CABANAYAN

B. WHERE LEAVE WILL BE SPENT

1. IN CASE OF VACATION LEAVE
( ) Within the Philippines
( ) Abroad (Specify)
2. IN CASE OF SICK LEAVE
( x ) In hospital(Specify)
(

) Out Patient (Specify)

D. COMMUTATION
(
(

) Requested
) Not Requested
RICHARD C. AMOGUIS
Name & Signature of Applicant

DETAILS OF APPLICATION
Total
b) RECOMMENDATION
(
(

Less:

) Approval
) Disapproval due to

Balance:
7. a) CERT. OF LEAVE CREDITS
As of ______________________

CYNTHIA JOCELYN V. MANLULU

Adm. Officer IV
c) APPROVED FOR:
______________________days with pay
______________________days without pay
______________________others (Specify)

REGGIE G. CABARAL
Head of Office
d) DISAPPROVED DUE TO :
_____________________________
_____________________________
_____________________________

Original Copy Employees Copy

Duplicate COA
Triplicate HRM Office

ARNEL WENCESLAO Z. HERNANDEZ

Vice Mayor