Revised 1988

1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

OFFICE OF THE ELECTION OFFICER
COMMISSION ON ELECTIONS GEALOGO ALFONSO JIMENEZ
CORTES, SURIGAO DEL SUR

3. DATE OF FILING 4. POSITION 5. SALARY (Monthly)

________________________ Election Assistant - II P 17,209.00
DETAILS FOR APPLICATION

6. TYPE OF LEAVE 6. b) WHERE LEAVE WILL BE SPENT

(1) IN CASE OF VACATION LEAVE
Vacation
Within the Philippines
To seek employment
Abroad (specify) _____________
Other (specify) ______________________________
(2) IN CASE OF SICK LEAVE
Sick In hospital (specify) ________
______________________________
Maternity
Out Patient (specify) _______
Others (specify)___________ _______________________________
c.) NUMBER OF WORKING DAYS APPLIED FOR: d) COMMUTATION
______________________________________ Registered Not Registered
INCLUSIVES DATES:
____________________________________ __________________________________
Signature of Applicant
DETAILS OF ACTION OF APPLICATION
7. a) CERTIFICATION OF LEAVE CREDITS 7 b) RECOMMENDATION
as of _______________________________
Approval
VACATION SICK TOTAL
Disapproval due to _______________
Days Days Days ___________________________________

__________________________________
(Personnel Officer) _______________________________
(Authorized Official)
7. c) APPROVED FOR: 7. d) RECOMMENDATION
___________ days with pay Approval
___________ days without pay
Disapproved due to _________
___________ others (specify) ___________________
___________________

EUTEMIO L. ESTOSE
Election Officer II