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LEAVE APPLICATION

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About the Form

Official leave application template for municipal employees.

This page provides a dedicated fillable leave application layout based on the approved boxed A4 format used for employee leave requests.

Employees may review the template online and download the same document in Word or PDF format for printing and submission.

Employee Form

Download the leave application in A4 Word or PDF format.

The files below follow the same formal layout as the reference sheet and are prepared for standard A4 printing.

Download Word Download PDF

Civil Service Form No. 6

Revised 2020

Annex A-2

Republic of the Philippines

Municipality of Agdangan

Human Resource Management Office

APPLICATION FOR LEAVE

Stamp of Date of Receipt

1. Office / Department 2. Name

3. Date of Filing 4. Position 5. Salary

6. DETAILS OF APPLICATION

6.A Type of Leave to Be Availed Of

Vacation Leave Mandatory / Forced Leave Sick Leave Maternity Leave Paternity Leave Special Privilege Leave Solo Parent Leave Study Leave 10-Day VAWC Leave Rehabilitation Privilege Special Leave Benefits for Women Calamity Leave Others

6.B Details of Leave

In case of Vacation / Special Privilege Leave In case of Sick Leave In case of Special Leave Benefits for Women In case of Study Leave / Other Purpose

6.C Number of Working Days Applied For

Working Days Inclusive Dates

6.D Commutation

Not Requested Requested

Signature of Applicant

7. DETAILS OF ACTION ON APPLICATION

7.A Certification of Leave Credits

As Of

Vacation Leave Sick Leave

Total Earned

Less This Application

Balance

Authorized Officer

7.B Recommendation

For approval For disapproval due to

Recommendation Details Immediate Head

7.C Approved For

Days With Pay Days Without Pay Others

7.D Disapproved Due To

Reason

Authorized Official

Office Unit Telephone No. E-mail Address

Municipality of Agdangan Human Resource Management Office (042) 421 5551 mgoagdangan@gmail.com

Office Hours Monday to Friday, 8:00 AM to 5:00 PM

Municipality of Agdangan

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Agdangan, Quezon, Philippines