APPLICATION FOR LEAVE

CSC Form No. 6

Revised 1984

RIDMD/PRO71. Office / Agency

GIPATALAGAN AL RAMOS 1178462. Name (Last) (First) (Middle) (Badge Nr)

February 26, 20153. Date of filing Permanent4. Position (Status of Apptmt) 5. Salary/P23,513.00

(Detail of Application)

6.a) Type of Leave

/ / vacation

/ / to seek employment

/ / others (specify)

/ / sick

/ / maternity

/ / others (specify)

6. b) Where leave will be spent:

(1) In case of vacation leave

/ / within the Philippines

/ / abroad (specify) ____________________________________

(2) In case of sick leave

In hospital (specify)(specify)

6. c) Number of working days applied ford) Supplement data:

1. DEM/PS ____________________

2. Last Leave enjoyed ___________

3. For COP, Designated OIC

d) Commutation

/ / requested / / not requested

________________________________________

Signature of Applicant

_Poblacion,Aloguinsan,Cebu_______________________________________Present Address

DETAILS OF ACTION APPLICATION

7. A) Certificate of leave credits

as of ______________________________7. B) Recommendation

/ / Approval

/ / Disapproval due to

Vacation

Sick

Total

_____________________________

Personnel OfficerREY LYNDON TOLEDO LAWAS Police Senior Superintendent

Chief, RIDMD7 _______________________________________ Authorized Official

Approved for:

Disapproved due to:

_____________________Days with pay

_________________________________

_____________________Days without pay

_________________________________

_____________________Others (specify)

_________________________________

_______________________________

Signature

________________________________

(Authorized Official)