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Leave Form

Katrina Bianca T. Inocentes, a Court Attorney V, applied for 4 days of vacation leave from November 23 to 26, 2021. The application form documents the type of leave requested, the inclusive dates, and requires certification of leave credits and recommendation for approval or disapproval. It will be approved or disapproved by an authorized official who will sign the final section.

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Kat Inocentes
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67 views

Leave Form

Katrina Bianca T. Inocentes, a Court Attorney V, applied for 4 days of vacation leave from November 23 to 26, 2021. The application form documents the type of leave requested, the inclusive dates, and requires certification of leave credits and recommendation for approval or disapproval. It will be approved or disapproved by an authorized official who will sign the final section.

Uploaded by

Kat Inocentes
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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Civil Service Form No.

6
Revised 2020

Republic of the Philippines


Stamp of Date of Receipt
Court of Appeals
Manila

APPLICATION FOR LEAVE


1. OFFICE/DEPARTMENT 2. NAME : (Last) (First) (Middle)

J. Bonifacio S. Pascua Inocentes Katrina Bianca T.

23 November 2021
3. DATE OF FILING ______________ 4. POSITION Court Attorney V 5. SALARY _______________

6. DETAILS OF APPLICATION
6.A TYPE OF LEAVE TO BE AVAILED OF 6.B DETAILS OF LEAVE

X Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Within the Philippines __________________________
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Abroad (Specify) _____________________________
Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS) In case of Sick Leave:
Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended) In Hospital (Specify Illness) _____________________
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Out Patient (Specify Illness) ____________________
Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004) _____________________________________________
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Special Leave Benefits for Women:
10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005) (Specify Illness) ________________________________
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) _____________________________________________
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) In case of Study Leave:
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Completion of Master's Degree
Adoption Leave (R.A. No. 8552) BAR/Board Examination Review
Wellness Leave (SC MC NO. 3, 2021 [CJ CARES]) Other purpose:
Others: Monetization of Leave Credits
_____________________________________ Terminal Leave

6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION

4 days Not Requested


INCLUSIVE DATES Requested
November 23 – 26, 2021 Atty. Katrina Bianca T. Inocentes
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION


As of _______________________ For approval
Vacation Leave Sick Leave For disapproval due to ________________________
Total Earned ___________________________________________
Less this application ___________________________________________
Balance ___________________________________________

___________________________________________
(Authorized Officer) (Authorized Officer)

7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:


_______ days with pay _______________________________________
_______ days without pay ___________________________________________
_______ others (Specify) ___________________________________________

_________________________________
(Authorized Official)

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