SECTION VI I — CENTRAL VI SAYAS

Schools Division of Cebu Province

Office of the Schools Division

Superintendent

April 30, 2021

DIVISION MEMORANDUM
No. IQ, s. 2021

UTILIZATION OF THE RRVTSED CXC FORM iS IN T2JE APPLICATION OF LEAVE

To: Assistant Schools Division Superintendents

Division Chief Supervisor
Education Program Supervisors/ Specialists
Public Schools District Supervisors/District in-Charge
Elementary and Secondary School Heads
Elementary and Secondary Teachers
All Others Concerned

1. The iieici is informed and directeci to u tiiize the revised ISO form 6 iia the
application for leave of absence, both teaching and non-teaching, effective
immediately.

2. Attached is the template of the CSC Form O Revised 2020, for reference.

3. Widest and immediate dissem natlOfl and guidance of all c oncerned.

xai E Es », CESO V
Scho vision Superinteiideiit

Address: IPHO Bldg„ Su‹llon, Lahug, Cebu City

Telephone Nos.: (032) 255-?i4 05
Email Address: ceb t.provif ce‹¿wdeped.gov.pI
 ANNEX A

Republic of the Philippines

SCHOOIS DIVISION OF CEBU PROUl'NCE
Stattg of Dab of
Receipt

APPLICATION FOR LEAVE

1. OFFICE/DEPARTMENT 2. NAME (Last) (First) (Middle)

, 3. OATEOF FILING 4. POSITION 5. SALARY

6. DETAILS OF APPLICATION
6.A TYPE OF LEAVE TO BE AVAILED OF 6.B DETAILS OF LEAVE
Vacation Leave ‹w. 51, Rab XVI, Omnibus Rubs lrrplerrerbng E O. No. 292) In Case O/ V’acafion 3pecia/ Privf/ege Leave:
Mandatory/Forced Leave(sec. 25, Rule XVI. Omnbus Rules lrrglementng E.O. No. 292) W4hin the Philippines
Sic? Leave ls•• ‹a, Rae xvi, omâus Ru!es)rrplemenGngE.O. .LI». 292) Abroad (Specify}
Maternity Leave \Ra «. 11210/ BR issued by CSC, DOLE a›d sss Lal In case of Sick Leave:
Paternity Leave tna w. s 8z/ cscUc No.71, s 1598, as amended} § } in Hospital (Specify illness)
Special Privilege Leave ‹s+c. 21, Rule XVI, Ormbus Rules Irrpbmentng E.O. No. Nez) Out Patient (Specify Illness)
Solo Parent Leave tu m. sszz / CSG MC No. 8, . 2004)
Study Leave (sec. 68, Rde xvi, e n6us Rules irrplernwwg E.O. No. 292) In case of Speéal Leave Benefits for Women.
L_J10-Day VAWC Leave (u «. szez / csC uc No. 15, . 2005) (Specify Illness)
Rehabilitation Privilege ts•c. s5. Rue XVI, Omnbus Rubs lmplemeréng E.O. No. 292)
Special Leave Benefits for Women \Pe a gz10/ CSC UP. No. 25. . 2010) In case of Study Leave.
Special Emergency (Calamity) Leave Ecsc uc N» 2, 20j2, as amended) Completion of Master’s Degree
Adoption Leave CRA No. 8552) BAR/Board Examination Review
Other purpose.
Others: Monetization of Leave Credits
Terminal Leave

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

Not Requested
Requested

(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION
7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of For approval
For disapproval due to
Vacation Sick Leave Others
Leave

(Authorized Officer)
(Authorized Officer)
7.C APPROVED FOR: 7.D DISAPPROVEO OUE TO:
days with pay
days without pay
others (Specify)

(Authorized Official)