0% found this document useful (0 votes)
106 views4 pages

CS Form No. 6 Revised 2020 Application For Leave

This document is a Civil Service Form No. 6 for applying for leave from the Department of Education Division of Agusan del Sur. It requires the applicant to provide details of the type of leave being applied for, the number of working days, and inclusive dates. It also includes sections for certifying leave credits, recommendations on the application, and approval or disapproval of the leave. Instructions are provided for the documentary requirements for different types of leaves such as vacation leave, sick leave, maternity leave, and study leave.

Uploaded by

Allan Galdiano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
106 views4 pages

CS Form No. 6 Revised 2020 Application For Leave

This document is a Civil Service Form No. 6 for applying for leave from the Department of Education Division of Agusan del Sur. It requires the applicant to provide details of the type of leave being applied for, the number of working days, and inclusive dates. It also includes sections for certifying leave credits, recommendations on the application, and approval or disapproval of the leave. Instructions are provided for the documentary requirements for different types of leaves such as vacation leave, sick leave, maternity leave, and study leave.

Uploaded by

Allan Galdiano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

pCivil Service Form No.

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

APPLICATION FOR LEAVE


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

NOVO GLEMARIE MASUANGAT


JUNE 27, 2022 Teacher I 25, 439.00

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

105 days Not Requested

INCLUSIVE DATES Requested

July 19, 2022 – October 31, 2022

(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

ALLAN J. GALDIANO
RESBA P. MORADO
(Authorized Officer)

Administrative Officer IV

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

_______ days with pay

days without pay

others (Specify)

MINERVA T. ALBIS, PhD.

Schools Division Superintendent


INSTRUCTIONS AND REQUIREMENTS

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 *

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 the form for purposes of securing travel 9. VAWC leave – 10 days
authority and completing clearance from money and work  It shall be filed in advance or immediately upon the woman employee’s
accountabilities. return from such leave.
 It shall be accompanied by any of the following supporting documents:
a. Barangay Protection Order (BPO) obtained from the barangay;
b. Temporary/Permanent Protection Order (TPO/PPO) obtained from the
2. Mandatory/Forced leave court;
c. If the protection order is not yet issued by the barangay or the court, a
Annual five-day vacation leave shall be forfeited if not taken during the year.
certification issued by the Punong Barangay/Kagawad or Prosecutor
In case the scheduled leave has been cancelled in the exigency of the service
or the Clerk of Court that the application for the BPO,
by the head of agency, it shall no longer be deducted from the accumulated
vacation leave. Availment of one (1) day or more Vacation Leave (VL)
shall be considered for complying the mandatory/forced leave subject to
the conditions under Section 25, Rule XVI of the Omnibus Rules Implementing
E.O. No. 292.

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.

4. Maternity leave* – 105 days


 Proof of pregnancy e.g. ultrasound, doctor’s certificate on the
expected date of delivery
 Accomplished Notice of Allocation of Maternity Leave Credits (CS Form
No. 6a), if needed
 Seconded female employees shall enjoy maternity leave with full pay in
the recipient agency.

5. Paternity leave – 7 days


Proof of child’s delivery e.g. birth certificate, medical certificate and
marriage contract

6. Special Privilege leave – 3 days


It shall be filed/approved for at least one (1) week prior to availment,
except on emergency cases. Special privilege leave within the
Philippines or abroad shall be indicated in the form for purposes of
securing travel authority and completing clearance from money and work
accountabilities.

7. Solo Parent leave – 7 days


It shall be filed in advance or whenever possible five (5) days before going
on such leave with updated Solo Parent Identification Card.
TPO or PPO has been filed with the said office shall be sufficient to operative period (period of confinement around surgery); as well as the
support the application for the ten-day leave; or employees estimated period of recuperation for the same.

d. In the absence of the BPO/TPO/PPO or the certification, a police


report specifying the details of the occurrence of violence on the
victim and a medical certificate may be considered, at the
discretion of the immediate supervisor of the woman employee 12. Special Emergency (Calamity)
concerned.
leave – up to 5 days
 The special emergency leave can be applied for a maximum of five

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

months shall be enjoyed once a year, not in every instance of calamity or


disaster.
 Application shall be made within one (1) week from the time of the
accident except when a longer period is warranted.  The head of office shall take full responsibility for the grant of special
 Letter request supported by relevant reports such as the police emergency leave and verification of the employee’s eligibility to be
report, if any, granted thereof. Said verification shall include: validation of place of
 Medical certificate on the nature of the injuries, the course of residence based on latest available records of the affected
treatment involved, and the need to undergo rest, recuperation, and employee; verification that the place of residence is covered in the
rehabilitation, as the case may be. declaration of calamity area by the proper government agency; and
 Written concurrence of a government physician should be obtained such other proofs as may be necessary.
relative to the recommendation for rehabilitation if the attending
physician is a private practitioner, particularly on the duration of the
period of rehabilitation.
13. Monetization of leave credits
Application for monetization of fifty percent (50%) or more of the
accumulated leave credits shall be accompanied by letter request to the
11. Special leave benefits for head of the agency stating the valid and justifiable reasons.

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).

You might also like