_______
Revised 1984
M M D D Y Y Y Y
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT
______________________________
Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION OF LEAVE 7. b) RECOMMENDATION
As of ______________________ Approved
Disapproved due to ____________________
VACATION SICK TOTAL ____________________________________
______________________________ ______________________________
Personnel Officer Authorized Official
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:
_________________________________
Authorized Official