Republic of the Philippines BULACAN STATE UNIVERSITY
City of Malolos, Bulacan
APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. NAME
(Last) (First) (Middle)
3. DATE OF FILING 4. POSITION 5. SALARY
(Monthly)
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE [ ] VACATION
[ ] To seek employment [ ] OTHERS (Specify) [ ] SICK
[ ] MATERNITY [ ] OTHERS (Specify)
6. b) NUMBER OF WORKING DAYS
APPLIED FOR: _________________________
INCLUSIVE DATES: _____________________
_____________________________________
6. c) WHERE LEAVE WILL BE SPENT (1) IN CASE OF VACATION LEAVE
[ ] With in the Philippines
[ ] Abroad (Specify) _____________________
(2) IN CASE OF SICK LEAVE [ ] In hospital (Specify)
_______________________________________
[ ] Out Patient (Specify)
_______________________________________
6. d) COMMUTATION
[ ] Requested [ ] Not Requested
_____________________________________
(Signature of Applicant)
DETAILS OF ACTION ON APPLICATION
7. a) CERTIFICATION LEAVE CREDITS
As of ___________________________________________
7. b) RECOMMENDATION [ ] Approved
[ ] Disapproved due to ____________________
____________________________________
EDGARDO M. SANTOS, Ph.D.
Vice President for Academic Affairs
VACATION SICK TOTAL
(Days) (Days) (Days)
CARMELITA B. SANGA, RGC
Director, Human Resource Management Office
7. c) APPROVED FOR : ____________ Days with pay ____________ Days without pay ____________ Others (Specify)
7. d) DISAPPROVED DUE TO:
________________________________________
CECILIA N. GASCON, Ph.D.
University President ______________________
Date
Republic of the Philippines BULACAN STATE UNIVERSITY
City of Malolos, Bulacan
APPLICATION FOR LEAVE
1. OFFICE/AGENCY 2. NAME
(Last) (First) (Middle)
3. DATE OF FILING 4. POSITION 5. SALARY
(Monthly)
DETAILS OF APPLICATION
6. a) TYPE OF LEAVE [ ] VACATION
[ ] To seek employment [ ] OTHERS (Specify) [ ] SICK
[ ] MATERNITY [ ] OTHERS (Specify)
6. b) NUMBER OF WORKING DAYS
APPLIED FOR: _________________________
INCLUSIVE DATES: _____________________
_____________________________________
6. c) WHERE LEAVE WILL BE SPENT (3) IN CASE OF VACATION LEAVE
[ ] With in the Philippines
[ ] Abroad (Specify) _____________________
(4) IN CASE OF SICK LEAVE [ ] In hospital (Specify)
_______________________________________
[ ] Out Patient (Specify)
_______________________________________
6. d) COMMUTATION
[ ] Requested [ ] Not Requested
_____________________________________
(Signature of Applicant)
DETAILS OF ACTION ON APPLICATION
CSC Form No. 6
CSC Form No. 6
7. a) CERTIFICATION LEAVE CREDITS
As of ___________________________________________
7. b) RECOMMENDATION [ ] Approved
[ ] Disapproved due to ____________________
____________________________________
EDGARDO M. SANTOS, Ph.D.
Vice President for Academic Affairs
VACATION SICK TOTAL
(Days) (Days) (Days)
CARMELITA B. SANGA, RGC
Director, Human Resource Management Office 7. c) APPROVED FOR :
____________ Days with pay ____________ Days without pay ____________ Others (Specify)
7. d) DISAPPROVED DUE TO:
________________________________________
CECILIA N. GASCON, Ph.D.
University President ______________________
Date
INSTRUCTIONS
1. Application for vacation or sick leave of one full day or more shall be made on this form and to be accomplished at least in duplicate 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 advanced, or exceeding five (5) days shall be accompanied by a medical certificate. In case medical consultation was not availed of, an affidavit shall 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 authorized leave of absent.
5. An application of leave of absences for thirty (30) calendar days or more shall be accompanied by a clearance from money and property accountabilities.
CHECKLIST OF REQUIREMENTS FOR SICK/VACATION LEAVE
Medical Certificate (sick leave more than 5 days but less than 30 days CSC form no. 41 (sick leave 30 calendar days or more)
University Clearance (leave 30 calendar days or more) Others: _________________________________
CARMELITA B. SANGA, RGC Director, Human Resource Management Office
CHECLIST OF REQUIREMENTS FOR TERMINAL LEAVE
SALN
Letter of Retirement GSIS clearance
Others:
CARMELITA B. SANGA, RGC Director, Human Resource Management Office
INSTRUCTIONS
1. Application for vacation or sick leave of one full day or more shall be made on this form and to be accomplished at least in duplicate form.
2. Application for vacation leave shall be filed in advance or whenever possible, five (5) days before going on such leave.
6. Application for sick leave filed in advanced, or exceeding five (5) days shall be accompanied by a medical certificate. In case medical consultation was not availed of, an affidavit shall be executed by the applicant.
3. An employee who is absent without approved leave shall not be entitled to receive his salary corresponding to the period of his authorized leave of absent.
4. An application of leave of absences for thirty (30) calendar days or more shall be accompanied by a clearance from money and property accountabilities.
CHECKLIST OF REQUIREMENTS FOR SICK/VACATION LEAVE
Medical Certificate (sick leave more than 5 days but less than 30 days CSC form no. 41 (sick leave 30 calendar days or more)
University Clearance (leave 30 calendar days or more) Others: _________________________________
CARMELITA B. SANGA, RGC Director, Human Resource Management Office
CHECLIST OF REQUIREMENTS FOR TERMINAL LEAVE
SALN
Letter of Retirement GSIS clearance
Others:
