CS Form No. 6 Revised 2020 Application For Leave
CS Form No. 6 Revised 2020 Application For Leave
6
Revised 2020
ANNEX A
Republic of the Philippines
Stamp of Date of Receipt
Department of Education
Division of Agusan del Sur
Government Center, Patin-ay, Prosperidad, Agusan del Sur
6. DETAILS OF APPLICATION
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)
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
Other purpose:
(Signature of Applicant)
As of For approval
Total Earned
Balance
ALLAN J. GALDIANO
RESBA P. MORADO
(Authorized Officer)
Administrative Officer IV
others (Specify)
Application for any type of leave shall be made on this Form and to be
accomplished at least in duplicate with documentary requirements, as follows: 8. Study leave* – up to 6 months
Shall meet the agency’s internal requirements, if any;
Contract between the agency head or authorized representative and the
employee concerned.
1. Vacation leave *
3. Sick leave*
It shall be filed immediately upon employee's return from such leave.
If filed in advance or exceeding five (5) days, application shall be
accompanied by a medical certificate. In case medical consultation was
not availed of, an affidavit should be executed by an applicant.
10. Rehabilitation leave* – up to 6 (5) straight working days or staggered basis within thirty (30) days from
the actual occurrence of the natural calamity/disaster. Said privilege
women* – up to 2 months
The application may be filed in advance, that is, at least five (5) days prior
to the scheduled date of the gynecological surgery that will be
undergone by the employee. In case of emergency, the application for
14. Terminal leave*
special leave shall be filed immediately upon employee’s return but Proof of employee’s resignation or retirement or separation from the
during confinement the agency shall be notified of said surgery. service.
The application shall be accompanied by a medical certificate filled out
by the proper medical authorities, e.g. the attending surgeon
accompanied by a clinical summary reflecting the gynecological
disorder which shall be addressed or was addressed by the said
surgery; the histopathological report; the operative technique used
15. Adoption Leave
Application for adoption leave shall be filed with an authenticated copy
for the surgery; the duration of the surgery including the peri- 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).