ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
Civil Service Form No. 6
Revised 2020
2
Republic of the Philippines
3
Department of Education
4
Region VI –Western Visayas
5
SCHOOLS DIVISION OF ANTIQUE
6
APPLICATION FOR LEAVE
7
1. OFFICE/DEPARTMENT
2. NAME : (Last) (First) (Middle)
8
9
3. DATE OF FILING ______________
4. POSITION _____________________________ 5. SALARY _______________
10
11
6. DETAILS OF APPLICATION
12
6.A TYPE OF LEAVE TO BE AVAILED OF
6.B DETAILS OF LEAVE
13
14
Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
In case of Vacation/Special Privilege Leave:
15
16
Mandatory/Forced Leave(Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Within the Philippines __________________________
17
18
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Abroad (Specify) _____________________________
19
20
Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS)
In case of Sick Leave:
21
22
Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended)
In Hospital (Specify Illness) _____________________
23
24
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Out Patient (Specify Illness) ____________________
25
26
Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004)
_____________________________________________
27
28
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
In case of Special Leave Benefits for Women:
29
30
10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005)
(Specify Illness) ________________________________
31
32
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
_____________________________________________
33
34
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010)
In case of Study Leave:
35
36
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended)
Completion of Master's Degree
37
38
Adoption Leave (R.A. No. 8552)
BAR/Board Examination Review
39
40
Other purpose:
41
42
Others:
Monetization of Leave Credits
43
44
_____________________________________
Terminal Leave
45
46
6.C NUMBER OF WORKING DAYS APPLIED FOR
6.D COMMUTATION
47
48
________________________________________
Not Requested
49
50
INCLUSIVE DATESRequested
51
________________________________________
52
(Signature of Applicant)
53
7. DETAILS OF ACTION ON APPLICATION
54
7.A CERTIFICATION OF LEAVE CREDITS
7.B RECOMMENDATION
55
56
As of _______________________
For approval
57
58
Vacation LeaveSick LeaveFor disapproval due to ________________________
59
Total Earned___________________________________________
60
Less this application___________________________________________
61
Balance___________________________________________
62
___________________________________________
63
Administrative Officer IVSchools Division Superintendent
64
7.C APPROVED FOR:
7.D DISAPPROVED DUE TO:
65
_______ days with pay_______________________________________
66
_______ days without pay___________________________________________
67
_______ others (Specify)___________________________________________
68


RAMIR B. UYTICO EdD, CESO III
Regional Director
Office of the Regional Director
(Authorized Official)
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100