Civil Service Form

No. 6 Revised 2020 ANNEX A

Republic of the Philippines

Department of Education Stamp of Date of
Receipt
Division of Sultan Kudarat

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

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)
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) In case of Study Leave: Completion of

Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Master's Degree BAR/Board

Adoption Leave (R.A. No. 8552) Examination Review

Other purpose:
Others: Monetization of Leave Credits
Terminal Leave

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

Not Requested
INCLUSIVE DATES Requested

(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

ROWENA JESSETTE S. VILLA (Authorized Officer)

Administrative Officer IV
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:
days with pay
days without pay
others (Specify)

CRISPIN A. SOLIVEN JR., CESE

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