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Civil Service Form No. 6
Revised 2020
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Republic of the Philippines
DEPARTMENT OF EDUCATION
SCHOOLS DIVISION OFFICE OF MOUNTAIN PROVINCE
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APPLICATION FOR LEAVE
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1. OFFICE/DEPARTMENT
2. NAME : (Last) (First) (Middle)
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Barlig, Mountain ProvinceMAINGAG,JEANETTEK
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3. DATE OF FILING
4. POSITIONTeacher lll
5. SALARY
33,722.00
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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 CLAIM
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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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33 days unused service credit
Not Requested
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INCLUSIVE DATES
Requested
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JEANETTE K. MAINGAG
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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
7.B RECOMMENDATION
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As of : January 31,2023
For approval
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Vacation LeaveSick Leave
For disapproval due to ________________________
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Total Earned7.17357.1735
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Less this application
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Balance7.17357.1735
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GRACE A. MASKITLEONIE P. SAROL
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Administrative Asst. lllHead Teacher lll
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7.C APPROVED FOR:
7.D DISAPPROVED DUE TO:
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14.347 days with pay
_______________________________________
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_______ days without pay
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_______ others (Specify)
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BNEILDA M. DAYTACAEdD,CESO V
BENILDA M. DAYTACA EdD,CESO V
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 Schools Division.Superintendent
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