Civil Service Form No.

6 Republic of the Philippines ANNEX A

Revised 2020
Department of Education Stamp of Date of Receipt

Region VII, Central Visayas

DIVISION OF LAPU – LAPU CITY
B.M. Dimataga St., Poblacion, Lapu-Lapu City

APPLICATION FOR LEAVE

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

ADMIN CANE ZOE REDIDO

3. DATE OF FILING 11/16/23 4. POSITION ADMINISTRATIVE AIDE VI 5. SALARY ₱ 17,553.00

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) In case of Special Leave Benefits for Women:
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) (Specify Illness)
10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005)

Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Study Leave:
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) Completion of Master's Degree

Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) BAR/Board Examination Review
Adoption Leave (R.A. No. 8552) Other Purpose:

Others: Monetization of Leave Credits

Terminal Leave

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

2 days Not Requested

INCLUSIVE DATES Requested

November 23 and 24, 2023

CONTENTS NOTED:

_______________________
(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

Authorized Officer

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

days with pay
days without pay
others (Specify)

MARILYN S. ANDALES EdD, CESO V

Schools Division Superintendent

INSTRUCTIONS AND REQUIREMENTS

Application for any type of leave shall be made on this Form and to be d. In the absence of the BPO/TPO/PPO or the certification, a police
accomplished at least in duplicate with documentary requirements, as follows: report specifying the details of the occurrence of violence on the
victim and a medical certificate may be considered, at the discretion
1. Vacation leave* of the immediate supervisor of the woman employee concerned.
It shall be filed five (5) days in advance, whenever possible, of the effective date of
such leave. Vacation leave within in the Philippines or abroad shall be indicated in 10. Rehabilitation leave* – up to 6 months
the form for purposes of securing travel authority and completing clearance from • Application shall be made within one (1) week from the time of the
money and work accountabilities. accident except when a longer period is warranted.
• Letter request supported by relevant reports such as the police
2. Mandatory/Forced leave report, if any,
Annual five-day vacation leave shall be forfeited if not taken during the year. In • Medical certificate on the nature of the injuries, the course of
case the scheduled leave has been cancelled in the exigency of the service by the treatment involved, and the need to undergo rest, recuperation, and
head of agency, it shall no longer be deducted from the accumulated vacation rehabilitation, as the case may be.
leave. Availment of one (1) day or more Vacation Leave (VL) shall be considered • Written concurrence of a government physician should be obtained
for complying the mandatory/forced leave subject to the conditions under Section relative to the recommendation for rehabilitation if the attending
25, Rule XVI of the Omnibus Rules Implementing E.O. No. 292. physician is a private practitioner, particularly on the duration of the
period of rehabilitation.
3. Sick leave*
• It shall be filed immediately upon employee's return from such leave. 11. Special leave benefits for women* – up to 2 months
• If filed in advance or exceeding five (5) days, application shall be accompanied by • The application may be filed in advance, that is, at least five (5)
a medical certificate. In case medical consultation was not availed of, an affidavit days prior to the scheduled date of the gynecological surgery that
should be executed by an applicant. will be undergone by the employee. In case of emergency, the
application for special leave shall be filed immediately upon
4. Maternity leave* – 105 days employee’s return but during confinement the agency shall be
• Proof of pregnancy e.g. ultrasound, doctor’s certificate on the expected date of notified of said surgery.
delivery • The application shall be accompanied by a medical certificate filled
• Accomplished Notice of Allocation of Maternity Leave Credits (CS Form No. 6a), if out by the proper medical authorities, e.g. the attending surgeon
needed accompanied by a clinical summary reflecting the gynecological
• Seconded female employees shall enjoy maternity leave with full pay in the disorder which shall be addressed or was addressed by the said
recipient agency. surgery; the histopathological report; the operative technique used
for the surgery; the duration of the surgery including the
5. Paternity leave – 7 days perioperative period (period of confinement around surgery); as well
Proof of child’s delivery e.g. birth certificate, medical certificate and marriage as the employees estimated period of recuperation for the same.
contract
12. Special Emergency (Calamity) leave – up to 5 days
6. Special Privilege leave – 3 days • The special emergency leave can be applied for a maximum of five
It shall be filed/approved for at least one (1) week prior to availment, except on (5) straight working days or staggered basis within thirty (30) days
emergency cases. Special privilege leave within the Philippines or abroad shall be from the actual occurrence of the natural calamity/disaster. Said
indicated in the form for purposes of securing travel authority and completing privilege shall be enjoyed once a year, not in every instance of
clearance from money and work accountabilities. calamity or disaster.
• The head of office shall take full responsibility for the grant of
7. Solo Parent leave – 7 days special emergency leave and verification of the employee’s eligibility
It shall be filed in advance or whenever possible five (5) days before going on such to be granted thereof. Said verification shall include: validation of
leave with updated Solo Parent Identification Card. place of residence based on latest available records of the affected
employee; verification that the place of residence is covered in the
8. Study leave* – up to 6 months declaration of calamity area by the proper government agency; and
• Shall meet the agency’s internal requirements, if any; such other proofs as may be necessary.
• Contract between the agency head or authorized representative and the employee
concerned. 13. Monetization of leave credits
Application for monetization of fifty percent (50%) or more of the
9. VAWC leave – 10 days accumulated leave credits shall be accompanied by letter request to
• It shall be filed in advance or immediately upon the woman employee’s return from the head of the agency stating the valid and justifiable reasons.
such leave.
• It shall be accompanied by any of the following supporting documents: 14. Terminal leave*
a. Barangay Protection Order (BPO) obtained from the barangay; Proof of employee’s resignation or retirement or separation from the
b. Temporary/Permanent Protection Order (TPO/PPO) obtained from the court; service.
c. If the protection order is not yet issued by the barangay or the court, a
certification issued by the Punong Barangay/Kagawad or 15. Adoption Leave
Prosecutor or the Clerk of Court that the application for the BPO, TPO or PPO has • Application for adoption leave shall be filed with an authenticated
been filed with the said office shall be sufficient to support the application for the copy of the Pre-Adoptive Placement Authority issued by the
ten-day leave; or Department of Social Welfare and Development (DSWD).
 Application for monetization of fifty percent (50%) or more of the
9. VAWC leave – 10 days accumulated leave credits shall be accompanied by letter request to
• It shall be filed in advance or immediately upon the woman employee’s return from the head of the agency stating the valid and justifiable reasons.
such leave.
• It shall be accompanied by any of the following supporting documents: 14. Terminal leave*
a. Barangay Protection Order (BPO) obtained from the barangay; Proof of employee’s resignation or retirement or separation from the
b. Temporary/Permanent Protection Order (TPO/PPO) obtained from the court; service.
c. If the protection order is not yet issued by the barangay or the court, a
certification issued by the Punong Barangay/Kagawad or 15. Adoption Leave
Prosecutor or the Clerk of Court that the application for the BPO, TPO or PPO has • Application for adoption leave shall be filed with an authenticated
been filed with the said office shall be sufficient to support the application for the copy of the Pre-Adoptive Placement Authority issued by the
ten-day leave; or Department of Social Welfare and Development (DSWD).

* For leave of absence for thirty (30) calendar days or more and terminal leave, application shall be accompanied by a clearance from money, property
and work-related accountabilities (pursuant to CSC Memorandum Circular No. 2, s. 1985).