Blank Form 6

Civil Service Form No.
6
Revised 2020
Republic of the Philippines

Department of Education
Schools Division Office - Marikina City
191 Shoe Ave., Sta. Elena, Marikina City
APPLICATION FOR LEAVE

1 OFFICE/DEPARTMENT 2 NAME (Last) (First) (Middle)
CONCEPCION INTEGRATED SCHOOL-SL SANTOS JOAN CRUZ
3 DATE OF FILING NOV. 18, 2022 4 POSITION TEACHER I 5 SALARY PHP25 439.00
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) FEVER
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

TWO (2) Not Requested
INCLUSIVE DATES ✘ Requested
NOVEMBER 16 & 17, 2022
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of OCTOBER 1, 2022 ✘ For approval 2 DAYS - SLWOP
Vacation Leave Sick Leave For disapproval due to
Total Earned - 0
Less this application - -
Balance - 0
AMELIE S. BINAYAS GLENDA M. TRINIDAD

Administrative Officer IV - HRMO Principal II
(Authorized Officer) (Authorized Officer)
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:

_______ days with pay
_______ days without pay
_______ others (Specify)
MA. ROSE JOCELYN T. TALACAN

Administrative Officer V
(Authorized Official)
Civil Service Form No. 6
Revised 2020


CONCEPCION INTEGRATED SCHOOL-SL SANTOS JOAN CRUZ
3 DATE OF FILING NOV. 18, 2022 4 POSITION TEACHER I 5 SALARY PHP25 439.00
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Abroad (Specify)
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Out Patient (Specify Illness)
FAMILY OBLIGATION Monetization of Leave Credits
Terminal Leave

TWO (2) Not Requested
NOVEMBER 16 & 17, 2022

As of OCTOBER 1, 2022 ✘ For approval 2 DAYS - LWOP
Total Earned - 16.451
Less this application - -
Balance - 16.451



Revised 2020


CONCEPCION INTEGRATED SCHOOL-SL CREDO EFRELYN NUÑEZ
3 DATE OF FILING DEC. 12, 2022 4 POSITION TEACHER II 5 SALARY PHP27 608.00
✘ Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Abroad (Specify)
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292) ✘ Out Patient (Specify Illness) Fever & cough
Monetization of Leave Credits
Terminal Leave

(ONE) 1 Not Requested
DECEMBER 12, 2022

As of DECEMBER 06, 2022 ✘ For approval 1 DAY - SLWP
Total Earned 0 8.5
Less this application 0 1
Balance 0 7.5



Revised 2020


CONCEPCION INTEGRATED SCHOOL-SL OBIADO MECHAELA REYN SANTOS
3 DATE OF FILING NOV. 29, 2022 4 POSITION ADMINISTRATIVE ASSISTANT II 5 SALARY PHP18 998.00
MONETIZATION Monetization of Leave Credits
Terminal Leave

THIRTY (30) Not Requested
INCLUSIVE DATES Requested

As of DECEMBER 1, 2022 ✘ For approval 30 DAYS - MONETIZATION
Total Earned 60.75 58.5
Balance 30.75 58.5
AMELIE S. BINAYAS MA. ROSE JOCELYN T. TALACAN

Administrative Officer IV - HRMO Administrative Officer V


Revised 2020


CONCEPCION INTEGRATED SCHOOL-SL OBIADO MECHAELA REYN SANTOS
3 DATE OF FILING DEC. 06, 2022 4 POSITION ADMINISTRATIVE ASSISTANT II 5 SALARY PHP18 998.00
MONETIZATION Monetization of Leave Credits
Terminal Leave

THIRTY (30) Not Requested
INCLUSIVE DATES Requested

As of DECEMBER 01, 2022 ✘ For approval 30 DAYS - MONETIZATION
Total Earned 60.75 58.5
Balance 30.75 58.5
AMELIE S. BINAYAS MA. ROSE JOCELYN T. TALACAN

Administrative Officer IV - HRMO Administrative Officer V

SHERYLL T. GAYOLA
Schools Division Superintendent
INSTRUCTIONS AND REQUIREMENTS
Application for any type of leave shall be made on this Form and to be c. If the protection order is not yet issued by the barangay or the
accomplished at least in duplicate with documentary requirements, as court, a certification issued by the Punong Barangay/Kagawad
follows:
* For leave of absence for thirty (30) calendar days or more and terminal leave, applicationor Prosecutor
shall or the Clerk
be accompanied of Court from
by a clearance that the application
money, propertyfor
andthe
work-related accountabilities (pursuant to CSC Memorandum Circular No. 2, s. 1985). BPO, TPO or PPO has been filed with the said office shall be
1. Vacation leave* sufficient to support the application for the ten-day leave; or
It shall be filed five (5) days in advance, whenever possible, of the d. In the absence of the BPO/TPO/PPO or the certification, a police
effective date of such leave. Vacation leave within in the Philippines report specifying the details of the occurrence of violence on the
or abroad shall be indicated in the form for purposes of securing travel victim and a medical certificate may be considered, at the
authority and completing clearance from money and work discretion of the immediate supervisor of the woman employee
accountabilities. concerned.
2. Mandatory/Forced leave 10. Rehabilitation leave* – up to 6 months

Annual five-day vacation leave shall be forfeited if not taken during  Application shall be made within one (1) week from the time of
the year. In case the scheduled leave has been cancelled in the the accident except when a longer period is warranted.
exigency of the service by the head of agency, it shall no longer be  Letter request supported by relevant reports such as the police
deducted from the accumulated vacation leave. Availment of one (1) report, if any,
day or more Vacation Leave (VL) shall be considered for complying  Medical certificate on the nature of the injuries, the course of
the mandatory/forced leave subject to the conditions under Section treatment involved, and the need to undergo rest, recuperation,
25, Rule XVI of the Omnibus Rules Implementing E.O. No. 292. and rehabilitation, as the case may be.
 Written concurrence of a government physician should be
3. Sick leave* obtained relative to the recommendation for rehabilitation if the
 It shall be filed immediately upon employee's return from such attending physician is a private practitioner, particularly on the
leave. duration of the period of rehabilitation.
 If filed in advance or exceeding five (5) days, application shall be
accompanied by a medical certificate. In case medical 11. Special leave benefits for women* – up to 2 months
consultation was not availed of, an affidavit should be executed by  The application may be filed in advance, that is, at least five (5)
an applicant. days prior to the scheduled date of the gynecological surgery that
will be undergone by the employee. In case of emergency, the
4. Maternity leave* – 105 days application for special leave shall be filed immediately upon
 Proof of pregnancy e.g. ultrasound, doctor’s certificate on the employee’s return but during confinement the agency shall be
expected date of delivery notified of said surgery.
 Accomplished Notice of Allocation of Maternity Leave Credits (CS  The application shall be accompanied by a medical certificate
Form No. 6a), if needed filled out by the proper medical authorities, e.g. the attending
 Seconded female employees shall enjoy maternity leave with full surgeon accompanied by a clinical summary reflecting the
pay in the recipient agency. gynecological disorder which shall be addressed or was
addressed by the said surgery; the histopathological report; the
5. Paternity leave – 7 days operative technique used for the surgery; the duration of the
Proof of child’s delivery e.g. birth certificate, medical certificate and surgery including the peri-operative period (period of confinement
marriage contract around surgery); as well as the employees estimated period of
recuperation for the same.
6. Special Privilege leave – 3 days
It shall be filed/approved for at least one (1) week prior to availment, 12. Special Emergency (Calamity) leave – up to 5 days
except on emergency cases. Special privilege leave within the  The special emergency leave can be applied for a maximum of
Philippines or abroad shall be indicated in the form for purposes of five (5) straight working days or staggered basis within thirty (30)
securing travel authority and completing clearance from money and days from the actual occurrence of the natural calamity/disaster.
work accountabilities. Said privilege shall be enjoyed once a year, not in every instance
of calamity or disaster.
7. Solo Parent leave – 7 days  The head of office shall take full responsibility for the grant of
It shall be filed in advance or whenever possible five (5) days before special emergency leave and verification of the employee’s
going on such leave with updated Solo Parent Identification Card. eligibility to be granted thereof. Said verification shall include:
validation of place of residence based on latest available records
8. Study leave* – up to 6 months of the affected employee; verification that the place of residence
 Shall meet the agency’s internal requirements, if any; is covered in the declaration of calamity area by the proper
 Contract between the agency head or authorized representative government agency; and such other proofs as may be necessary.
and the employee concerned.
13. Monetization of leave credits
9. VAWC leave – 10 days Application for monetization of fifty percent (50%) or more of the
 It shall be filed in advance or immediately upon the woman accumulated leave credits shall be accompanied by letter request to
employee’s return from such leave. the head of the agency stating the valid and justifiable reasons.
 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 the
b. Temporary/Permanent Protection Order (TPO/PPO) obtained service.
from the court;

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Civil Service Form No.

Republic of the Philippines

APPLICATION FOR LEAVE

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

7. DETAILS OF ACTION ON APPLICATION

AMELIE S. BINAYAS GLENDA M. TRINIDAD

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

MA. ROSE JOCELYN T. TALACAN

Republic of the Philippines

APPLICATION FOR LEAVE

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

7. DETAILS OF ACTION ON APPLICATION

AMELIE S. BINAYAS GLENDA M. TRINIDAD

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

MA. ROSE JOCELYN T. TALACAN

Republic of the Philippines

APPLICATION FOR LEAVE

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

7. DETAILS OF ACTION ON APPLICATION

AMELIE S. BINAYAS GLENDA M. TRINIDAD

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

MA. ROSE JOCELYN T. TALACAN

Republic of the Philippines

APPLICATION FOR LEAVE

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

7. DETAILS OF ACTION ON APPLICATION

AMELIE S. BINAYAS MA. ROSE JOCELYN T. TALACAN

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

MA. ROSE JOCELYN T. TALACAN

Republic of the Philippines

APPLICATION FOR LEAVE

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

7. DETAILS OF ACTION ON APPLICATION

AMELIE S. BINAYAS MA. ROSE JOCELYN T. TALACAN

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

2. Mandatory/Forced leave 10. Rehabilitation leave* – up to 6 months

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