ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Civil Service Form No. 6
Revised 2020
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Republic of the Philippines
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Department of Education
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Cordillera Administrative Region
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Schools Division of Ifugao
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Rizal Avenue, Poblacion South, Lagawe, Ifugao
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APPLICATION FOR LEAVE
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1. OFFICE/DEPARTMENT
2. NAME : (Last) (First) (Middle)
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3. DATE OF FILING ______________
4. POSITION _____________________________ 5. SALARY _______________
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6. DETAILS OF APPLICATION
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6.A TYPE OF LEAVE TO BE AVAILED OF
6.B DETAILS OF LEAVE
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Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
In case of Vacation/Special Privilege Leave:
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Mandatory/Forced Leave(Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Within the Philippines __________________________
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Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Abroad (Specify) _____________________________
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Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS)
In case of Sick Leave:
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Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended)
In Hospital (Specify Illness) _____________________
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Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Out Patient (Specify Illness) ____________________
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Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004)
_____________________________________________
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Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
In case of Special Leave Benefits for Women:
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10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005)
(Specify Illness) ________________________________
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Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
_____________________________________________
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Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010)
In case of Study Leave:
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Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended)
Completion of Master's Degree
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Adoption Leave (R.A. No. 8552)
BAR/Board Examination Review
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Other purpose:
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Others:
Monetization of Leave Credits
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_____________________________________
Terminal Leave
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6.C NUMBER OF WORKING DAYS APPLIED FOR
6.D COMMUTATION
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Not Requested
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INCLUSIVE DATESRequested
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________________________________________
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(Signature of Applicant)
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7. DETAILS OF ACTION ON APPLICATION
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7.A CERTIFICATION OF LEAVE CREDITS as of ___________
7.B RECOMMENDATION
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For approval
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Vacation LeaveSick LeaveSPLCOCOthers
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For disapproval due to ________________________
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Total Earned___________________________________________
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Less this application___________________________________________
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Balance___________________________________________
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___________________________________________
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Administrative Assistant IISchool Head
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7.C APPROVED FOR:
7.D DISAPPROVED DUE TO:
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_______ days with pay_______________________________________
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_______ days without pay___________________________________________
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_______ others (Specify)___________________________________________
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PIO D. ECUAN EdD
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Chief Supervising Officer
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OIC-ASDS
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 Rizal Ave., Poblacion South, Lagawe, Ifugao
Email: ifugao@deped.gov.ph
Website: https://www.depedcarifugao.com
Letter Head Ref: DepEd Order 31, s. 2019

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