Elective Local Officials Personal Data Sheet

DILG personal data sheet for elective local officials

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DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
DILG-NAPOLCOM Center, EDSA cor. Quezon Avenue, Quezon City
www.dilg.gov.ph

APPLICATION FOR LEAVE
Name

CSC Form No. (Revised 1985)

TYPE OF LEAVE

Signature

VACATION

Mo. Salary

Within the Philippines

Abroad (Specify)

Position
Office/Division

SICK

Date of Filing

Out Patient (specify)

In In Hospital (specify)

No. of working days applied for
Inclusive Dates

FORCED LEAVE

CSC-SPL

COMMUTATION:

MATERNITY

REHABILITATION

TERMINAL

Others (specify)

Requested

Not Requested

FOR PERSONNEL USE ONLY:
VL

ACTION ON APPLICATION
Recommending:
SL

Leave credits as of

TOTAL
Approval
Disapproval due to

Less: This Leave
Balance:
[Autohorized Official]
CERTIFIED BY:
APPROVED FOR
Chief, Personnel Section/Division

Days w/ Pay
Days w/o Pay
DISAPPROVED DUE TO

Carded by:
Date:
[Authorized Official]