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Application For Leave

Annie Dela Peña, a DMO V at the Department of Health, is applying for 1 day of sick leave from April 11-12, 2017. She will be spending her leave as an outpatient and is not requesting commutation. Her leave application was recommended for approval by Annabelle P. Yumang and authorized by the Secretary of Health.

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78 views

Application For Leave

Annie Dela Peña, a DMO V at the Department of Health, is applying for 1 day of sick leave from April 11-12, 2017. She will be spending her leave as an outpatient and is not requesting commutation. Her leave application was recommended for approval by Annabelle P. Yumang and authorized by the Secretary of Health.

Uploaded by

ronaldsagang83
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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APPLICATION FOR LEAVE

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


DOH LA ROSA ANNIE DELA PEA
3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)
APRIL 12, 2017 DMO V
DETAILS OF APPLICATION
6. a.) TYPE OF LEAVE b.) Where leave will be spent:
[ ] VACATION
[ ] To seek employment 1. In case of Vacation Leave:
Others (Specify)___________________ [ ] Within the Philippines
[ / ] SICK [ ] MATERNITY
[ ] TERMINAL [ ] PATERNITY _________________________
SPECIAL PRIV. (Pls. check approp. Box) (Forwarding Address)
[ ] Govt./Personal Transaction [ ] Abroad (Specify) _______________
[ ] Hospitalization [ ] Accident
[ ] Enrolment [ ] Graduation 2. In case of Sick Leave:
[ ] Relocation [ ] Calamity [ ] In Hospital (Specify)_____________
[ ] Birthday [ ] Out Patient (Specify) ______________
[ ] Wedding/Wedding Anniversary Leave d.) Commutation:
[ ] OTHERS (Specify) ________ [ ] Requested
[ ] Not Requested

c.) NO. OF WORKING DAYS


APPLIED: 1
Inclusive Dates: APRIL 11, 2017 (Signature of Applicant)

DETAILS OF ACTION ON APPLICATION

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


[ ] APPROVAL as of_________________________
[ ] DISAPPROVAL DUE TO: VACATION SICK
Less this leave :________ _________
ANNABELLE P. YUMANG, MD,MCH Balance :________ _________
(Authorized Official)

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


______________Days With Pay ________________________________
______________Days Without Pay ________________________________
______________Days w/ HALF/FULL Pay _________________________________
______________OTHERS (Specify) _________________________________

BY AUTHORITY OF THE SECRETARY OF HEALTH:

___________________________________________________

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