KAGAWARAN NG INTERYOR AT PAMAHALAANG LOKAL (Department of the Interior and Local Government) Regional Office IX F.S. Fajares San jose District Pagadian City CSC Form No. 6 APPLICATION Revised 1984 1. OFFICE/AGENCY FOR LEAVE 2. NAME (Last) DILG-RO IX (First) EGAMA 3. DATE OF FILING (Middle) ELMER LACAYA 4. POSITION AUGUST 10, 2012 5. SALARY (Monthly) STAT.I DETAILS OF APPLICATION 6. TYPE OF LEAVE x VACATION (FORCED LEAVE) To seek employment Others (Specify) Sick Leave Maternity Terminal Others (Specify) ______ 7. WHERE LEAVE WILL BE SPENT: (1) IN CASE OF VACATION LEAVE Within the Philippines Abroad (specify) _________________________________________ (2) IN CASE OF SICK LEAVE In-Hospital Out-Patient (Specify) _______________ 8. NUMBER OF WORKING DAY APPLIED FOR AUGUST 23 & 30, 2012 INCLUSIVE DATES (3) COMMUTATION Requested Not Requested (Signature of Applicant) DETAILS OF ACTION ON APPLICATION 9. CERTIFICATION OF LEAVE CREDITS AS OF _______________________________ RECOMMENDATION ( ) APPROVED VACATION SICK TOTAL ( ) DISAPPROVED DUE TO _______________________ _________________________________________________ __EVA N. SABANAL FIORELLO G. ELIZAGA Administrative Officer IV 10. APPROVED FOR: DAYS WITH PAY DAYS WITHOUT PAY Chief, LGMED ( Authorized Official) 11. DISAPPROVED DUE TO: _____________________________________ _____________________________________ PAISAL O, ABUTAZIL, CESO III Regional Director KAGAWARAN NG INTERYOR AT PAMAHALAANG LOKAL (Department of the Interior and Local Government) Regional Office IX F.S. Fajares San jose District Pagadian City CSC Form No. 6 APPLICATION Revised 1984 1. OFFICE/AGENCY FOR LEAVE 2. NAME (Last) DILG-RO IX RULE 3. DATE OF FILING (First) (Middle) RACHELLE AGUILAR 4. POSITION JANUARY 27, 2011 5. SALARY (Monthly) LGOO II DETAILS OF APPLICATION 6. TYPE OF LEAVE / VACATION To seek employment Others(Specify) / Maternity Terminal Others (Specify) _______________ 7. WHERE LEAVE WILL BE SPENT: (1) IN CASE OF VACATION LEAVE Within the Philippines Abroad (specify) _________________________________________ (2) IN CASE OF SICK LEAVE In-Hospital Out-Patient (Specify) ________________ 8. NUMBER OF WORKING DAY APPLIED FOR 2 days INCLUSIVE DATES January 28 & 31, 2011 (3) COMMUTATION Requested Not Requested (Signature of Applicant) DETAILS OF ACTION ON APPLICATION 9. CERTIFICATION OF LEAVE CREDITS AS OF _______________________________ RECOMMENDATION ( ) APPROVED VACATION SICK TOTAL ( ) DISAPPROVED DUE TO _______________________ _________________________________________________ LOURDES V. UTUTALUM FIORELLO G. ELIZAGA Human Resource Management Officer III Chief, LGMED (Authorized Official) 10. APPROVED FOR: DAYS WITH PAY DAYS WITHOUT PAY 11. DISAPPROVED DUE TO: _____________________________________ _____________________________________ PAISAL O, ABUTAZIL, CESO III Regional Director