Civil Service Form No.

6
Revised 2020
ANNEX A
Republic of the Philippines
National Bureau of Investigation
Taft Avenue, Ermita, Manila Stamp of Date of Receipt

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

In case of Vacation/Special Privilege Leave:

Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Within the Philippines ___________________________
Mandatory/Forced Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292) __

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

Others: Other Purpose:

______________________________________________________ Monetization of Leave Credits

Terminal Leave

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

Requested
INCLUSIVE DATES Not Requested

(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION

As of_________________________________ For approval

For disapproval due to
Vacation Leave Sick Leave
Total Earned
Less this application
Balance

RICARDO M. RODAJE, MD.

(Authorized Officer) (Authorized Officer)

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

________days with pay

________days without pay
________others (Specify)

______________________________________
(Authorized Official)
 INSTRUCTIONS AND REQUIREMENTS

Application for any type of leave shall be made on this Form and to TPO or PPO has been filed with the said office shall be
be accomplished at least in duplicate with documentary requirements, sufficient to support the application for the ten-day leave; or
as follows: d. In the absence of the BPO/TPO/PPO or the certification, a
police report specifying the details of the occurrence of
1. Vacation leave * violence on the victim and a medical certificate may be
It shall be filed five (5) days in advance, whenever possible, of the considered, at the discretion of the immediate supervisor of
effective date of such leave. Vacation leave within in the Philippines the woman employee concerned.
orabroad shall be indicated in the form for purposes of securing travel
authority and completing clearance from money and work 10. Rehabilitation leave* – up to 6 months
accountabilities.  Application shall be made within one (1) week from the time of
the accident except when a longer period is warranted.
2. Mandatory/Forced leave  Letter request supported by relevant reports such as the police
Annual five-day vacation leave shall be forfeited if not taken during report, if any,
the year. In case the scheduled leave has been cancelled in the  Medical certificate on the nature of the injuries, the course
exigency of the service by the head of agency, it shall no longer be of treatment involved, and the need to undergo rest, recuperation,
deducted from the accumulated vacation leave. Availment of one and rehabilitation, as the case may be.
(1) day or more Vacation Leave (VL) shall be considered for  Written concurrence of a government physician should be
complying the mandatory/forced leave subject to the conditions under obtainedrelative to the recommendation for rehabilitation if the
Section 25, Rule XVI of the Omnibus Rules Implementing E.O. No. attending physician is a private practitioner, particularly on the
292. duration of the period of rehabilitation.

3. Sick leave* 11. Special leave benefits for women* – up to 2 months

 It shall be filed immediately upon employee's return from such leave.  The application may be filed in advance, that is, at least five (5)
 If filed in advance or exceeding five (5) days, application shall days prior to the scheduled date of the gynecological surgery
be accompanied by a medical certificate. In case medical that will beundergone by the employee. In case of emergency,
consultation was not availed of, an affidavit should be executed by the application for special leave shall be filed immediately upon
an applicant. employee’s return but during confinement the agency shall be
notified of said surgery.
4. Maternity leave* – 105 days  The application shall be accompanied by a medical certificate
 Proof of pregnancy e.g. ultrasound, doctor’s certificate on filled out by the proper medical authorities, e.g. the attending
theexpected date of delivery surgeon accompanied by a clinical summary reflecting the
 Accomplished Notice of Allocation of Maternity Leave Credits gynecological disorder which shall be addressed or was
(CSForm No. 6a), if needed addressed by the said surgery; the histopathological report; the
 Seconded female employees shall enjoy maternity leave with full operative technique used for the surgery; the duration of the
pay in the recipient agency. surgery including the peri- operative period (period of
confinement around surgery); as well as the employees
5. Paternity leave – 7 days estimated period of recuperation for the same.
Proof of child’s delivery e.g. birth certificate, medical certificate and
marriage contract 12. Special Emergency (Calamity) leave – up to 5 days
 The special emergency leave can be applied for a maximum of five
6. Special Privilege leave – 3 days (5) straight working days or staggered basis within thirty (30)
It shall be filed/approved for at least one (1) week prior to availment, daysfrom the actual occurrence of the natural calamity/disaster.
except on emergency cases. Special privilege leave within the Said privilege shall be enjoyed once a year, not in every
Philippines or abroad shall be indicated in the form for purposes instance of calamity or disaster.
ofsecuring travel authority and completing clearance from money and  The head of office shall take full responsibility for the grant of
work accountabilities. special emergency leave and verification of the employee’s
eligibility to be granted thereof. Said verification shall include:
7. Solo Parent leave – 7 days validation of place of residence based on latest available
It shall be filed in advance or whenever possible five (5) days before records of the affected employee; verification that the place of
going on such leave with updated Solo Parent Identification Card. residence is covered in the declaration of calamity area by the
proper government agency; and such other proofs as may be
8. Study leave* – up to 6 months necessary.
 Shall meet the agency’s internal requirements, if any;
 Contract between the agency head or authorized representative 13. Monetization of leave credits
and the employee concerned. Application for monetization of fifty percent (50%) or more of
the accumulated leave credits shall be accompanied by letter
9. VAWC leave – 10 days request to the head of the agency stating the valid and justifiable
 It shall be filed in advance or immediately upon the woman reasons.
employee’s return from 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
b. Temporary/Permanent Protection Order (TPO/PPO) obtained from the service.
the court;
c. If the protection order is not yet issued by the barangay or the court, 15. Adoption Leave
a certification issued by the Punong Barangay/Kagawad or  Application for adoption leave shall be filed with an
Prosecutor or the Clerk of Court that the application for the BPO, authenticated copy of the Pre-Adoptive Placement Authority
issued by the 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).