APPLICATION FOR LEAVE CIVIL SERVICE COMMISSION-REGION IV 1. OFFICE/DEPT./DIVISION 2. NAME Municipal Health Office 3.

DATE OF FILING

LAST

FIRST

MIDDLE NAME

4. POSITION 6. DETAILS OF APPLICATION

Monthly Salary

6. a.) TYPE OF LEAVE ( ) Vacation Leave ( ) To seek employment ( ) Others ( Specify) ( ) Sick Leave ( ) Maternity Leave ( ) Others (Specify) ____________________________ c. NUMBER OF WORKING DAYS APPLIED FOR: INCLUSIVE DATE

b.) WHERE LEAVE WILL BE SENT 1. In case of Vacation Leave ( ) Within the Philippines ( ) Abroad (Specify) 2.) In case of Sick Leave ( ) In the hospital ( ) Out Patient ( Specify) d.) COMMUTATIONS ( ) Requested ( ) Not Requested

Signature of Applicant 7. DETAILS OF ACTION ON APPLICANT a.) CERTIFICATION OF LEAVE CREDITS As of ___________________, 20____ VACATIONS SICK TOTAL b.) RECOMMENDATION ( ) Approval ( ) Disapproval due to __________ ______________________ ______________________

VICENTE F. ROBLES JR. Municipal Government Department Head 1 Approved for: Day/s with pay Day/s without pay Others (Specify)

PEDRO P. LANDICHO, MD. Municipal Health Officer DISAPPROVED DUE TO:_____________________ _________________________________________

RAMON A. PREZA Municipal Mayor Tiaong, Quezon Note: 1. Application for vacation leave or sick leave for one full day or more shall be made on his form to be accomplished at least duplicate. 2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going on such leave. 3. Application for sick leave filed in advance or exceeding five days shall be accompanied by medical certificate. 4. An employee who is absent without approved leave shall not be entitled to received his salary corresponding to the period of his unauthorized leave of absence. 5. An application for leave of absence of thirty (30) calendar days or more shall be accompanied by a clearance from money and properly accountability.

APPLICATION FOR LEAVE CIVIL SERVICE COMMISSION-REGION IV 1. OFFICE/DEPT./DIVISION 2. NAME Municipal Health Office 3. DATE OF FILING

LAST

FIRST

MIDDLE NAME

4. POSITION 6. DETAILS OF APPLICATION

Monthly Salary

6. a.) TYPE OF LEAVE ( ) Vacation Leave ( ) To seek employment ( ) Others ( Specify) ( ) Sick Leave ( ) Maternity Leave ( ) Others (Specify) ____________________________ c. NUMBER OF WORKING DAYS APPLIED FOR: INCLUSIVE DATE

b.) WHERE LEAVE WILL BE SENT 1. In case of Vacation Leave ( ) Within the Philippines ( ) Abroad (Specify) 2.) In case of Sick Leave ( ) In the hospital ( ) Out Patient ( Specify) d.) COMMUTATIONS ( ) Requested ( ) Not Requested

Signature of Applicant 7. DETAILS OF ACTION ON APPLICANT a.) CERTIFICATION OF LEAVE CREDITS As of ___________________, 20____ VACATIONS SICK TOTAL b.) RECOMMENDATION ( ) Approval ( ) Disapproval due to __________ ______________________ ______________________

VICENTE F. ROBLES JR. Municipal Government Department Head 1 Approved for: Day/s with pay Day/s without pay Others (Specify)

PEDRO P. LANDICHO, MD. Municipal Health Officer

DISAPPROVED DUE TO:_____________________ _________________________________________

RAMON A. PREZA Municipal Mayor Tiaong, Quezon

Note: 1. Application for vacation leave or sick leave for one full day or more shall be made on his form to be accomplished at least duplicate. 2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going on such leave. 3. Application for sick leave filed in advance or exceeding five days shall be accompanied by medical certificate. 4. An employee who is absent without approved leave shall not be entitled to received his salary corresponding to the period of his unauthorized leave of absence. 5. An application for leave of absence of thirty (30) calendar days or more shall be accompanied by a clearance from money and properly accountability.