APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)
3. DATE OF FILING 4. POSITION 5. SALARY
6. DETAILS OF APPLICATION
6. a) TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT:
Vacation (1) IN CASE OF VACATION LEAVE
To seek employment Within the Philippines
Others (Specify) Abroad (Specify)
Sick (2) IN CASE OF SICK LEAVE
Maternity In Hospital (Specify
Others (Specify) Out Patient (Specify)
6. c) NUMBER OF WORKING DAYS APPLIED FOR: 6. d) COMMUTATION
Requested Not Requested
INCLUSIVE DATES
Signature of Applicant
7. DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
as of ___________________________
Vacation Sick Total Approval
Disapproval due to
Day/s Day/s Day/s
Personnel Officer (Authorized Official)
7. c) APPROVED FOR: 7. d) DISAPPROVED DUE TO:
day/s with pay
day/s without pay
others (specify)
SIGNATURE
AUTHORIZED OFFICIAL
DATE:
GUIDELINES ON FILING OF APPLICATION FOR LEAVE OF ABSENCE
INSTRUCTIONS
1. Application for vacation or sick leave of absence for one full day or more shall be made on this Form.
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 (5) days shall be accompanied by a medical certificate.
In case medical consultation was not availed of, and affidavit should be executed by the applicant.
4. An employee who is absent without approved leave shall not be entitled to received salary corresponding to the
period of his unauthorized leave of absence.
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.
