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CS Form No. 6 Revised 1984 - Application For Leave Form

This document is an application for leave form used by an office or agency. It collects information such as the applicant's name, position, salary, type of leave being requested (e.g. vacation, sick, maternity), number of working days for the leave, and commutation request. It also includes spaces for certifying the applicant's leave credits, recommending approval or disapproval of the application, and the authorized official's approval or disapproval decision. The back of the form provides instructions for completing the application, such as requiring advance notice or medical documentation depending on the type and length of leave requested.

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218 views

CS Form No. 6 Revised 1984 - Application For Leave Form

This document is an application for leave form used by an office or agency. It collects information such as the applicant's name, position, salary, type of leave being requested (e.g. vacation, sick, maternity), number of working days for the leave, and commutation request. It also includes spaces for certifying the applicant's leave credits, recommending approval or disapproval of the application, and the authorized official's approval or disapproval decision. The back of the form provides instructions for completing the application, such as requiring advance notice or medical documentation depending on the type and length of leave requested.

Uploaded by

Jedi Nasiad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CS Form No.

6
Revised 1984
APPLICATION FOR LEAVE

1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

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

6. DETAILS OF APPLICATION

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


o Vacation (1) IN CASE OF VACATION LEAVE
o To seek employment D Within the Philippines
- - - - -_
o Others (Specify) _ D Abroad (Specify)
(2) IN CASE OF SICK LEAVE
o Sick D In Hospital (Specify) _

D Maternity

D Others (Specify) _ D Out Patient (Specify) _

6. c) NUMBER OF WORKING DAYS APPLIED 6. d) COMMUTATION


FOR _
o Requested 0 Not Requested
INCLUSIVE DATES
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

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


As of _ D Approval

[ ] Disapproval due to _

Vacation Sick Total

Days Days Days

(Personnel Officer) (Authorized Official)

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

_ _ _ _ Days with pay

_ _ _ _ Days without pay

_ _ _ _ others (Specify)

(Signature)

(AUTHORIZED OFFICIAL)
DATE: _

(Please see instruction at the back)


INSTRUCTIONS

1. Application for vacation or sick leave for one full day or more
shall be made on this Form and to be accomplished at least in
duplicate.

2. Application for vacation leave shall be filled in advance or


whether possible five (5) days before going on such leave.

3. Application for sick-leave filed in advance, or exceeding five


(5) days shall be accompanied by a medical certificate. In case
medical consultations was not availed of, an affidavit should be
executed by the applicant.

4. An employee who is absent without approved leave shall not


be entitled to receive his salary corresponding to the period of
his unauthorized leave ofabsence.

5. An application for leave of absence for thirty (30) calendar


days or more shall be accompanied by a clearance from money
and property accountabilities.

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