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Leave Form-CS Form No. 6, Revised 2020

This document is a civil service form for applying for leave from the Department of Education in the Philippines. It collects information such as the applicant's name, position, salary, type of leave being applied for, number of days, and leave credit balances. The form is then reviewed and certified by administrative officers and can be approved or disapproved by the Schools Division Superintendent.

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Janine Gorday Tumampil Bornias
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© © All Rights Reserved
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45 views

Leave Form-CS Form No. 6, Revised 2020

This document is a civil service form for applying for leave from the Department of Education in the Philippines. It collects information such as the applicant's name, position, salary, type of leave being applied for, number of days, and leave credit balances. The form is then reviewed and certified by administrative officers and can be approved or disapproved by the Schools Division Superintendent.

Uploaded by

Janine Gorday Tumampil Bornias
Copyright
© © All Rights Reserved
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Civil Service Form No.

6
Revised 2020

Republic of the Philippines


Department of Education-Schools Division of Sarangani Stamp of Date of Receipt
Capitol Compound, Alabel, Sarangani Province

APPLICATION FOR LEAVE


1. OFFICE/DEPARTMENT 2. NAME : (Last) (First) (Middle)

3. DATE OF FILING ______________ 4. POSITION _____________________________ 5. SALARY _______________

6. DETAILS OF APPLICATION
6.A TYPE OF LEAVE TO BE AVAILED OF 6.B DETAILS OF LEAVE

Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Within the Philippines __________________________
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Abroad (Specify) _____________________________
Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS) In case of Sick Leave:
Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended) In Hospital (Specify Illness) _____________________
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Out Patient (Specify Illness) ____________________
Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004) _____________________________________________
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Special Leave Benefits for Women:
10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005) (Specify Illness) ________________________________
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) _____________________________________________
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) In case of Study Leave:
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Completion of Master's Degree
Adoption Leave (R.A. No. 8552) BAR/Board Examination Review
Other purpose:
Others: Monetization of Leave Credits
_____________________________________ Terminal Leave

6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION


________________________________________ Not Requested
INCLUSIVE DATES Requested
________________________________________
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION


7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of _______________________ For approval
Vacation Leave Sick Leave For disapproval due to ________________________
Total Earned ___________________________________________
Less this application ___________________________________________
Balance ___________________________________________

IRMA MAY G. DINASAS ___________________________________________


Administrative Officer V (Authorized Officer)

7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:


_______ days with pay _______________________________________
_______ days without pay ___________________________________________
_______ others (Specify) ___________________________________________

RUTH L. ESTACIO PhD, CESO VI


_________________________________
Schools Division Superintendent
Additional Information of Employee
Date of Original Appt.:
Employee No.:
Annual Salary:
Station No.:

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