Civil Service Form No, 6
Revise 2020
Republic of me Philippines
SCHOOLS DMSION OF CEBU PROVINCE
IPHO Bldg., Sudlon, Lahug, Cebu City
APPLICATION FOR LEAVE
OFFICE/DEPARTMENT 2. NAME (Last) (First) (Middle)
DATEOF FILING 4. POSITION 5, SALARY
e. DETAILS OF APPLICATION
6.B DETAILS OF LEAVE
6.A TYPE OF LEAVE TO BE AVAILED OF In case of Vacation/Specjal Privilege Leave:
Vacation Leave (Sec, 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Within the Philippines
Mandatory/Forced Leave(sec. 25, Rule XVI , Omnibus Rules Implementing E.O. No. 292) Abroad (Specjfy)
Sick Leave (Sec. Rule XVI No, 292) Omnibus Rules Implementing E.O. 292) In case of Sick Leave:
Maternity Leave (RA. No. 11210/ IRR issued by CSC, SSS)
In Hospital (Specify Illness)
Patemity Leave (RA No. 8187/ CSC MC No. 71, s. 1998, as amended)
Special Privilege Leave (Sec. 21. Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Out Patient (Specify Illness)
Solo Parent Leave (RA 8972 'CSC MC No. 8, s. 2004)
In case of Spedal Leave Benefits for Women:
Study Leave (Sec. 68, Rile Omnibus Rules Implementing E.O. No. 292)
(Specify Illness)
10-Day VAWC Leave (RA No. CSC MC 15: s. 2005)
Rehabilitation Privilege (Sec. 55. Omnibus Rules E.O. No. 292)
Special Leave for Women (RANQ. 9710 1 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 Masters Degree
Adoption Leave (RA No. 8552) BAR/Board Examination Review Other
purpose:
Monetization of Leave Credits
Terminal Leave
Other:
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION
Not Requested
INCLUSiVE DATES Requested
(Signature of Applicant)
DETAILS OF ACTION ON APPLICATION
7.A CERTIFICATION OF LEAVE CREDITS 7.8 RECOMMENDATION
As of
Vacation Sick Leave Others
Leave
Totd Eamed
Less Application
Balance
(Authorized Officer)
7.C APPROVED FOR, 70 DISAPPROVED DUE TO. days with pay
days without pay
others (Specify)
(Authorized Official)
ANNEX A
Stamp of Date of Receipt