CSC FORM NO.
06
REVISED 1994
OFFICE/AGENCY NAME : LAST FIRST MIDDLE
DATE OF FILING POSITION SALARY (MONTHLY)
P ______________
DETAILS OF APPLICANT
TYPE OF LEAVE: WHERE LEAVE WILL BE SPENT
IN CASE OF VACATION LEAVE
/ / VACATION LEAVE / / WITHIN THE PHILIPPINES
/ / TO SEEK EMPLOYMENT / / ABROAD (SPECIFY)
/ / OTHERS -
IN CASE OF SICK LEAVE –
/ / SICK / / IN HOSPITAL (SPECIFY)
/ / MATERNITY / / OUT PATIENT (SPECIFY)
/ / OTHERS ()
COMMUTATION
NUMBER OF WORKING DAYS APPLIED FOR: / / REQUESTED / / NOT REQUESTED
INCLUSIVE DATE:
SIGNATURE OF APPLICANT
CERTIFICATION OF LEAVE CREDITS AS OF: RECOMMENDATION:
/ / APPROVED
VACATION SICK TOTAL / / DISAPPROVED
DAYS DAYS DAYS
APPROVED FOR: DISAPPROVED DUE TO:
DAYS WITH PAY
DAYS WITHOUT PAY
DAYS (SPECIFY)
APPROVED:
____________________
Punong Barangay
Date:
1. Application for vacation or sick leave for one full day or more shall be made in this form to be at least
quadruplicate.
2. Application for vacation leave shall be filed in advance or whenever possible (5) days before going such
leave
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a medical
certificate. In case of medical consultation was not availed of an affidavit should be executed by
applicant.
4. An employee who is absent without approved leave shall not to received his salary corresponding to the
period of his authorized leave of absence.
CSC FORM NO. 06
REVISED 1994
OFFICE/AGENCY NAME : LAST FIRST MIDDLE
OFFICE OF THE SANGGUNIANG BAYAN SECRETARY VERCELUZ, DOMINGO V.
DATE OF FILING POSITION SALARY (MONTHLY)
Municipal Councilor P46,259.00
APRIL 16 ,2019
DETAILS OF APPLICANT
TYPE OF LEAVE: WHERE LEAVE WILL BE SPENT
IN CASE OF VACATION LEAVE
/ / VACATION LEAVE / / WITHIN THE PHILIPPINES
/ / TO SEEK EMPLOYMENT / / ABROAD (SPECIFY)
/ X / OTHERS – FORCED LEAVE
IN CASE OF SICK LEAVE
/ / SICK / / IN HOSPITAL (SPECIFY)
/ / MATERNITY / / OUT PATIENT (SPECIFY)
/ / OTHERS
COMMUTATION
NUMBER OF WORKING DAYS APPLIED FOR: / X / REQUESTED / / NOT REQUESTED
1- day
INCLUSIVE DATE:
APRIL 16, 2019 DOMINGO V . VERCELUZ
SIGNATURE OF APPLICANT
CERTIFICATION OF LEAVE CREDITS AS OF: RECOMMENDATION:
/ / APPROVED
VACATION SICK TOTAL / / DISAPPROVED
DAYS DAYS DAYS
MA. GLAIZA C. BERMUDO
Human Resource Management Officer
Authorized Official
APPROVED FOR: DISAPPROVED DUE TO:
One(1) DAYS WITH PAY
DAYS WITHOUT PAY
DAYS (SPECIFY)
APPROVED:
BAYANI B. VELUZ
Municipal Vice Mayor
Date:
1. Application for vacation or sick leave for one full day or more shall be made in this form to be at
least quadruplicate.
2. Application for vacation leave shall be filed in advance or whenever possible (5) days before
going such leave
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a
medical certificate. In case of medical consultation was not availed of an affidavit should be
executed by applicant.
4. An employee who is absent without approved leave shall not to received his salary
corresponding to the period of his authorized leave of absence.
5.
CSC FORM NO. 06
REVISED 1994
OFFICE/AGENCY NAME : LAST FIRST MIDDLE
OFFICE OF THE MUN. VICE MAYOR VILLAREAL ALLAN INOCENCIO
DATE OF FILING POSITION SALARY (MONTHLY)
April 28, 2016 MUNICIPAL VICE MAYOR P 40,298.00
DETAILS OF APPLICANT
TYPE OF LEAVE: WHERE LEAVE WILL BE SPENT
IN CASE OF VACATION LEAVE
/ / VACATION LEAVE / / WITHIN THE PHILIPPINES
/ / TO SEEK EMPLOYMENT / / ABROAD (SPECIFY)
/x / OTHERS (Forced Leave)
IN CASE OF SICK LEAVE
/ / SICK / / IN HOSPITAL (SPECIFY)
/ / MATERNITY / / OUT PATIENT (SPECIFY)
/ / OTHERS
COMMUTATION
NUMBER OF WORKING DAYS APPLIED FOR: / / REQUESTED / / NOT REQUESTED
1 day
INCLUSIVE DATE:
May 2, 2016 ALLAN I. VILLAREAL
SIGNATURE OF APPLICANT
CERTIFICATION OF LEAVE CREDITS AS OF: RECOMMENDATION:
/ / APPROVED
VACATION SICK TOTAL / / DISAPPROVED
DAYS DAYS DAYS
AILEEN N. GAYANILO
Administrative Assistant II
HRMO-Designate
Authorized Official
APPROVED FOR: DISAPPROVED DUE TO:
One(1) DAYS WITH PAY
DAYS WITHOUT PAY
DAYS (SPECIFY)
APPROVED:
LYDIA B. ABARIENTOS
Municipal Mayor
Date:
1. Application for vacation or sick leave for one full day or more shall be made in this form to be at
least quadruplicate.
2. Application for vacation leave shall be filed in advance or whenever possible (5) days before
going such leave
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a
medical certificate. In case of medical consultation was not availed of an affidavit should be
executed by applicant.
4. An employee who is absent without approved leave shall not to received his salary
corresponding to the period of his authorized leave of absence.
5.
CSC FORM NO. 06
REVISED 1994
OFFICE/AGENCY NAME : LAST FIRST MIDDLE
OFFICE OF THE MPDC PAULINO JULIET UMALI
DATE OF FILING POSITION SALARY (MONTHLY)
May 17, 2016 Administrative Aide I P 6,750.00
DETAILS OF APPLICANT
TYPE OF LEAVE: WHERE LEAVE WILL BE SPENT
IN CASE OF VACATION LEAVE
/ X / VACATION LEAVE / / WITHIN THE PHILIPPINES
/ / TO SEEK EMPLOYMENT / / ABROAD (SPECIFY)
/ / OTHERS
IN CASE OF SICK LEAVE
/ / SICK / / IN HOSPITAL (SPECIFY)
/ / MATERNITY / / OUT PATIENT (SPECIFY)
/ / OTHERS
COMMUTATION
NUMBER OF WORKING DAYS APPLIED FOR: / / REQUESTED / / NOT REQUESTED
Twenty (20) working days
INCLUSIVE DATE:
May 18 – June 14, 2016 JULIET U. PAULINO
SIGNATURE OF APPLICANT
CERTIFICATION OF LEAVE CREDITS AS OF: RECOMMENDATION:
/ / APPROVED
VACATION SICK TOTAL / / DISAPPROVED
DAYS DAYS DAYS
PAZ C. CAGUIMBAL
AILEEN N. GAYANILO MPDC
Administrative Assistant II
HRMO-Designate
Authorized Official
APPROVED FOR: DISAPPROVED DUE TO:
Twenty (20) DAYS WITH PAY
DAYS WITHOUT PAY
DAYS (SPECIFY)
APPROVED:
LYDIA B. ABARIENTOS
Municipal Mayor
Date:
1. Application for vacation or sick leave for one full day or more shall be made in this form to be at
least quadruplicate.
2. Application for vacation leave shall be filed in advance or whenever possible (5) days before
going such leave
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a
medical certificate. In case of medical consultation was not availed of an affidavit should be
executed by applicant.
4. An employee who is absent without approved leave shall not to received his salary
corresponding to the period of his authorized leave of absence.
5.
CSC FORM NO. 06
REVISED 1994
OFFICE/AGENCY NAME : LAST FIRST MIDDLE
OFFICE OF THE SB SECRETARY TERRENAL , EDUARDO RACASA
DATE OF FILING POSITION SALARY (MONTHLY)
August 13, 2019 ABC President P 46,259.00
DETAILS OF APPLICANT
TYPE OF LEAVE: WHERE LEAVE WILL BE SPENT
IN CASE OF VACATION LEAVE
/ / VACATION LEAVE / / WITHIN THE PHILIPPINES
/ / TO SEEK EMPLOYMENT / / ABROAD (SPECIFY)
/X / OTHERS - FORCED LEAVE
IN CASE OF SICK LEAVE
/ / SICK / / IN HOSPITAL (SPECIFY)
/ / MATERNITY / / OUT PATIENT (SPECIFY)
/ / OTHERS
COMMUTATION
NUMBER OF WORKING DAYS APPLIED FOR: / / REQUESTED / / NOT REQUESTED
INCLUSIVE DATE:
August 13, 2019 EDUARDO R. TERRENAL
SIGNATURE OF APPLICANT
CERTIFICATION OF LEAVE CREDITS AS OF: RECOMMENDATION:
/ X / APPROVED
VACATION SICK TOTAL / / DISAPPROVED
DAYS DAYS DAYS
MA. GLAIZA C. BERMUDO
Human Resource Management Officer
Authorized Official
APPROVED FOR: DISAPPROVED DUE TO:
One(1) DAYS WITH PAY
DAYS WITHOUT PAY
DAYS (SPECIFY)
APPROVED:
Hon/Atty. Cleto R. Suarilla
Municipal Vice Mayor
Date:
1. Application for vacation or sick leave for one full day or more shall be made in this form to be at
least quadruplicate.
2. Application for vacation leave shall be filed in advance or whenever possible (5) days before
going such leave
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a
medical certificate. In case of medical consultation was not availed of an affidavit should be
executed by applicant.
4. An employee who is absent without approved leave shall not to received his salary
corresponding to the period of his authorized leave of absence.
5.
CSC FORM NO. 06
REVISED 1994
OFFICE/AGENCY NAME : LAST FIRST MIDDLE
OFFICE OF THE SB SECRETARIAT GONZALEZ LANELITA JARIEL
DATE OF FILING POSITION SALARY (MONTHLY)
February 9, 2015 SB Secretary P 40,822.00
DETAILS OF APPLICANT
TYPE OF LEAVE: WHERE LEAVE WILL BE SPENT
IN CASE OF VACATION LEAVE
/ / VACATION LEAVE / / WITHIN THE PHILIPPINES
/ / TO SEEK EMPLOYMENT / / ABROAD (SPECIFY)
/ X / OTHERS
IN CASE OF SICK LEAVE
/ / SICK / / IN HOSPITAL (SPECIFY)
/ / MATERNITY / / OUT PATIENT (SPECIFY)
/ / OTHERS
COMMUTATION
NUMBER OF WORKING DAYS APPLIED FOR: / / REQUESTED / / NOT REQUESTED
INCLUSIVE DATE:
LANELITA J. GONZALEZ
SIGNATURE OF APPLICANT
CERTIFICATION OF LEAVE CREDITS AS OF: RECOMMENDATION:
/ / APPROVED
VACATION SICK TOTAL / / DISAPPROVED
DAYS DAYS DAYS
AILEEN N. GAYANILO
Administrative Assistant II
HRMO-Designate
Authorized Official
APPROVED FOR: DISAPPROVED DUE TO:
DAYS WITH PAY
DAYS WITHOUT PAY
DAYS (SPECIFY)
APPROVED:
ALLAN I. VILLAREAL
Municipal Vice Mayor
Date:
1. Application for vacation or sick leave for one full day or more shall be made in this form to be at
least quadruplicate.
2. Application for vacation leave shall be filed in advance or whenever possible (5) days before
going such leave
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a
medical certificate. In case of medical consultation was not availed of an affidavit should be
executed by applicant.
4. An employee who is absent without approved leave shall not to received his salary
corresponding to the period of his authorized leave of absence.
5.
