Civil Service Form No.

6 (Revised 1984) HRDO Control number:

1. AGENCY 1.1 DEPARTMENT/OFFICE 2. NAME: (Surname, Given Name,
(Indicate Mother Unit if TDY) M.I.)
City Government OSPITAL NG MAKATI
of ESTA, RODRIGO B.
MAKATI
3. DATE OF FILING 4. POSITION 4.1 STATUS OF APPOINTMENT 5. SALARY
NURSE 1 Regular Casual Contractual
FEB 20, 2019 First Day of Service: FEB. 6, Coterminous _____________ P 22179.00
2006
6. DETAILS OF APPLICATION
6a. TYPE OF LEAVE:
Vacation 6b. WHERE LEAVE WILL BE SPENT:
To seek employment  In case of VACATION LEAVE
x Others (specify) _________________ Within the Philippines x
Sick Leave: Abroad (specify)
Maternity/Paternity Leave In case of SICK LEAVE
Privilege Leave In Hospital (specify)
Others (specify) Out-patient (specify)
6d. COMMUTATION
6c. NUMBER OF DAYS APPLIED FOR: 3 DAYS___  Requested  Not Requested
INCLUSIVE DATES: MARCH 4, 5, 6, 2019
RODRIGO B. ESTA
SIGNATURE OF APPLICANT I
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7a. CERTIFICATION OF LEAVE CREDITS 7b. RECOMMENDATION
As of _____________________ 20  Approval
VACATION SICK TOTAL  Disapproval due to _________________________________
Earned : __________ _________ __________
Less : __________ _________ __________
Balance: __________ _________ __________
Computed by: Checked by: DR. VERGEL P. BINAY
OIC-HOSPITAL DIRECTOR
___________________ _____________________ Department / Office Head
(Signature over Printed name) (Signature over Printed name)

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7c. APPROVED FOR: Approved by:
________________________________________
7d. DISAPPROVED DUE TO: VISSIA MARIE P. ALDON

_______________________________________ City Personnel Officer

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Receiving Stamp/s Here
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 INSTRUCTIONS:
a. Application for vacation or sick leave for one full day or more shall be made on this form and
to be accomplished in THREE (3) COPIES.
b. Application for vacation leave shall be filed in advance or whether possible FIVE (5) DAYS
before going such leave.
c. Application for SICKLEAVE SHALL BE FILLED IMMEDIATELY upon employee’s return from such
leave and if sick leave is filed in advance or exceeding FIVE (5) DAYS shall be accompanied
by a medical certificate. In case medical consultation was not availed of, an affidavit should
be executed by the applicant.

 2011
d. An employee who is absent without approved leave shall not be entitled to receive his/her
salary corresponding to the period of his/her unauthorized leave of absence.
e. An application for leave of absence for THIRTY (30) CALENDAR DAYS or more shall be
accompanied by a clearance from money and property accountabilities.