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Department of Education: Application For Leave

This document is a Civil Service Form application for leave submitted by Darren C. Cariño, a Nurse II in the Department of Education Cordillera Administrative Region Schools Division Office of Abra. He is applying for 1 day of vacation leave on February 14, 2022. The form provides spaces to include details of the leave type being applied for, number of days, certification of leave credits, and areas for recommendation and approval or disapproval by authorized officers.

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Darren Cariño
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621 views2 pages

Department of Education: Application For Leave

This document is a Civil Service Form application for leave submitted by Darren C. Cariño, a Nurse II in the Department of Education Cordillera Administrative Region Schools Division Office of Abra. He is applying for 1 day of vacation leave on February 14, 2022. The form provides spaces to include details of the leave type being applied for, number of days, certification of leave credits, and areas for recommendation and approval or disapproval by authorized officers.

Uploaded by

Darren Cariño
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as XLSX, PDF, TXT or read online on Scribd
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Civil Service Form No.

6 ANNEX A
Revised 2020

Republic of the Philippines Stamp of Date of Receipt

Department of Education
Cordillera Administrative Region
SCHOOLS DIVISION OFFICE OF ABRA
APPLICATION FOR LEAVE
1. OFFICE/DEPARTMENT 2. NAME: (Last) (First) (Middle)
DEPED CARIÑO DARREN C.
3. DATE OF FILING January 19, 2022 4. POSITION NURSE II 5. SALARY PHP 37,044.00

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) In case of Study Leave:
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Completion of Master's Degree
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) BAR/Board Examination Review Other
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) purpose:
Adoption Leave (R.A. No. 8552) Monetization of Leave Credits

Others: Terminal Leave

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


1 Day Not Requested
INCLUSIVE DATES Requested
February 14, 2022 DARREN C. CARIÑO
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION


7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION

As of

Vacation Leave Sick Leave For approval


Total Earned
For disapproval due to
Less this application

Balance - -

GEMMA B. CABUTAJE, AO IV LEMUEL B. DICKSON, EdD


Administrative Office IV Chief Education Supervisor, SGOD
Authorized Officer Authorized Officer

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


days with pay
days without pay

others (Specify)

BENILDA M. DAYTACA,EdD, CESO VI


OIC-Schools Division Superintendent
Authorized Officer

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