APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

1. OFFICE/AGENCY 2. LAST NAME FIRST MIDDLE

DTI-LAGUNA ADRIANO ADRIMAR AQUINO

3. DATE OF FILING 4. POSITION 5. SALARY (MONTHLY)

NEGOSYO CENTER BUSINESS COUNSELLOR PHP 15,000

10-Dec-18

DETAILS OF APPLICATION

6. a). TYPE OF LEAVE 6. b). WHERE LEAVE WILL BE SPENT

Vacation In case of Vacation Leave
To seek employment Within the Philippines
Others (specify) Abroad (specify)

Sick In caseof Sick Leave

Maternity In Hospital (specify)
/ Others (specify) To attend church Out Patient (specify)
activity
6. c). Number of working days applied for 1 day 6. d). COMMUTATION

Inclusive dates / Requested Not requested

Signature of Applicant
DETAILS OF ACTION ON APPLICATION
7. a). CERTIFICATION OF LEAVE CREDITS 7. b). RECOMMENDATION
as of

Vacation Sick Total Approved

Disapproved
Days Days Days

MARCELINA B. ALCANTARA
KLYDE JOY B. BRUNO Chief, BDD
Administrative Officer II

7. c). APPROVED FOR: 7. d). DISAPPROVED DUE TO:

days w/ pay
days w/o pay
others (specify)

SUSAN R. PALO
Provincial Director