CSC Form No. 6Revised 1984

1. OFFICE/AGENCY : 2. NAME (Last) (First) (Middle) DOT-OTSR BUENO MARIA RICA CALVO 3. DATE OF FILING : 4. POSITION : 5. SALARY (Monthly) September 14, 2015 DIRECTOR

_________________________________________________________________ ____________________________

a.) TYPE OF LEAVE 6. b.) WHERE LEAVE WILL BE SPENT � VACATION (1) IN CASE OF VACATION LEAVE

� To seek employment � Within the Philippines � Others � Abroad (Specify) � SICK (2) IN CASE OF SICK LEAVE � MATERNITY � In Hospital (Specify) __________

� OTHERS (Specify) � Outpatient ___________________

6. c.) NUMBER OF WORKING DAYS 6. d.) COMMUTATION Five (5) days

INCLUSIVE DATE/S: ____________________________________ 14-16, 23-24 September 2015 Signature of Applicant

DETAILS OF ACTION ON APPLICATION

7. a.) CERTIFICATION OF LEAVE CREDITS 7. b.) RECOMMENDATIONas of ________, 2015 � Approval

� Disapproval Vacation Sick Total

ATTY. MARIA VICTORIA V. JASMIN

Undersecretary, TRCRG Authorized Official 7. c.) Approved for : 7. d.) Disapproved due to : _ _ day/s with pay ________ _________________ day/s w/out pay ____________________________ _________________ others (Specify) ____________________________

RAMON R. JIMENEZ, JR.Secretary

Authorized Official