CM Service Form No.

6
Revised 1020

Republic of the Philippine

Department of Eduction
Region XII
Schools Division of South Cotabato
Alunan Ave., Koronadal City

APPLICATION FOR LEAVE

1. OFFICE/DEPARTMENT 2. NAME: (Last) (First) (Middle)
DepEd South Cotabato MAGBALOT INGRID NOMAN
LAMBA NHS ALVERO NEMESIO MANARES

3. DATE OF FILING __________ 4. POSITION PRINCIPAL I 5. SALARY P 52, 088.00

6. DETAILS OF APPLICATION
6. A TYPE OF LEAVE TO BE VALID OF 6.B DETAILS OF LEAVE
Vacation Leave(Sec. 51,Rule XVI, Omnibus Rules Implementing E.O. No.292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(S.O.25,RuleXVI, Omnibus Rules Implementing E.O. No.292) with in the Philippines ____________________
Sick Leave (Sec.43,RuleXVI Omnibus Rules implementing E.O.No.292 Abroad (Specify) ____________________
Maternity Leave (R.A.No.11210/IRR issued by CSC, DOLE and SSS) In case of Sick Leave
Paternity Leave (R.A.No.8187/CSC MC No.71,s1998, as amended) In Hospital (Specify Illness) ___________________
Special Privilege Leave (Sec.21 Rule XVI Omnibus Rules Implementing E.O. No.292) Out Patient (Specify Illness) ___________________
Solo Parent Leave ( R.A. No. 8972/CSC MC No. 8,s.2004)
10-Day VAWC Leave (R.A.No.9262/CSC MC No.15,s.2005) In case of Special Leave benefit for Women
Rehabilitation Privilege(Sec.55 Rule XVI,Omnibus Rules Implementing E.O.No.292) (Specify Illness) _____________________________
Special Leave Benefit for Women (R.A.No.9710/CSCMCNo.25,s.2010)
Special Emergency(Calamity)Leave(CSC/MC No.2,s.2012,as amended) In case of Study Leave:
Adoption Leave (R.A. No.8552) completion of Master's Degree
BAR/Board Examination Review
Others: ____________________________ Other purpose:
Monetization of Leave Credits
Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED: 6.D COMMUTATION
Not Requested
Requested
FOR INCLUSIVE DATES:

(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 Leave Sick Leave
Total Earned
Less this application
Balance

ARLENE L. ALBUNA JASMIN P. ISLA

AO IV - PERSONNEL SECTION Assistant Schools Division Superintendent
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO: days with
184 pay
Days without pay
others (Specify)
 RUTH L. ESTACIO, Ph.D. CESO IV
Schools Division Superintendent
Office of the Schools Division Superintendent

Office/School : LAMBA NHS / BANGA 1

Data of Orig. Appt: April 15, 2002
Emplyee No.: 5401301
Station Code:
CM Service Form No.6
Revised 1020

Republic of the Philippine

Department of Eduction
Region XII
Schools Division of South Cotabato
Alunan Ave., Koronadal City

APPLICATION FOR LEAVE

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

3. DATE OF FILING 4. POSITION 5. SALARY

6. DETAILS OF APPLICATION
6. A TYPE OF LEAVE TO BE VALID OF 6.B DETAILS OF LEAVE
Vacation Leave(Sec. 51,Rule XVI, Omnibus Rules Implementing E.O. No.292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(S.O.25,RuleXVI, Omnibus Rules Implementing E.O. No.292) with in the Philippines ____________________
Sick Leave (Sec.43,RuleXVI Omnibus Rules implementing E.O.No.292 Abroad (Specify) ____________________
Maternity Leave (R.A.No.11210/IRR issued by CSC, DOLE and SSS) In case of Sick Leave
Paternity Leave (R.A.No.8187/CSC MC No.71,s1998, as amended) In Hospital (Specify Illness) ___________________
Special Privilege Leave (Sec.21 Rule XVI Omnibus Rules Implementing E.O. No.292) Out Patient (Specify Illness) ___________________
Solo Parent Leave ( R.A. No. 8972/CSC MC No. 8,s.2004)
10-Day VAWC Leave (R.A.No.9262/CSC MC No.15,s.2005) In case of Special Leave benefit for Women
Rehabilitation Privilege(Sec.55 Rule XVI,Omnibus Rules Implementing E.O.No.292) (Specify Illness) _____________________________
Special Leave Benefit for Women (R.A.No.9710/CSCMCNo.25,s.2010)
Special Emergency(Calamity)Leave(CSC/MC No.2,s.2012,as amended) In case of Study Leave:
Adoption Leave (R.A. No.8552) completion of Master's Degree
BAR/Board Examination Review
Others: ____________________________ Other purpose:
Monetization of Leave Credits
Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED: 6.D COMMUTATION
Not Requested
Requested
FOR INCLUSIVE DATES:

(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 Leave Sick Leave
Total Earned
Less this application
Balance

FLOR ANGELIE M. TOLONDON

Administrative Officer II School Head
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO: days with
pay
Days without pay
others (Specify)

JASMIN P. ISLA
Assistant Schools Division Superintendent
Office/School :
Data of Orig. Appt:
Emplyee No.:
Station Code:
CM Service Form No.6

Revised 1020

Republic of the Philippine

Department of Eduction
Region XII
Schools Division of South Cotabato
Alunan Ave., Koronadal City

APPLICATION FOR LEAVE

1. OFFICE/DEPARTMENT 2. NAME: (Last) (First) (Middle)
CARLOS L. LLASOS SR. ELEMENTARY SCHOOL LOSALA MARY ANGIELLE GASMIN
3. DATE OF FILING: MARCH 2,2023 4. POSITION: TEACHER III 5. SALARY P31,633.00
6. DETAILS OF APPLICATION
6. A TYPE OF LEAVE TO BE VALID OF 6.B DETAILS OF LEAVE
Vacation Leave(Sec. 51,Rule XVI, Omnibus Rules Implementing E.O. No.292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(S.O.25,RuleXVI, Omnibus Rules Implementing E.O. No.292) with in the Philippines ____________________
/ Sick Leave (Sec.43,RuleXVI Omnibus Rules implementing E.O.No.292 Abroad (Specify) ____________________
Maternity Leave (R.A.No.11210/IRR issued by CSC, DOLE and SSS) In case of Sick Leave
Paternity Leave (R.A.No.8187/CSC MC No.71,s1998, as amended) In Hospital (Specify Illness) ___________________
Special Privilege Leave (Sec.21 Rule XVI Omnibus Rules Implementing E.O. No.292) Out Patient (Specify Illness)
Solo Parent Leave ( R.A. No. 8972/CSC MC No. 8,s.2004) UPPER RESPIRATORY TRACK INFECTION
10-Day VAWC Leave (R.A.No.9262/CSC MC No.15,s.2005) In case of Special Leave benefit for Women
Rehabilitation Privilege(Sec.55 Rule XVI,Omnibus Rules Implementing E.O.No.292) (Specify Illness) _____________________________
Special Leave Benefit for Women (R.A.No.9710/CSCMCNo.25,s.2010)
Special Emergency(Calamity)Leave(CSC/MC No.2,s.2012,as amended) In case of Study Leave:
Adoption Leave (R.A. No.8552) completion of Master's Degree
BAR/Board Examination Review
Others: ____________________________ Other purpose:
Monetization of Leave Credits
Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED: 6.D COMMUTATION
3-DAYS Not Requested
Requested
FOR INCLUSIVE DATES:
FEBRUARY 27, 2023-MARCH 1, 2023
(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 LeaveSick Leave
Total Earned
Less this application
Balance

ARLENE L. ALBUNA JASMIN P. ISLA

AO IV - PERSONNEL SECTION Assistant Schools Division Superintendent
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO: days with
pay
Days without pay
others (Specify)

RUTH L. ESTACIO, Ph.D. CESO IV

Schools Division Superintendent

Office/School :
Data of Orig. Appt:
Emplyee No.:
Station Code:
CM Service Form No.6
Revised 1020

Republic of the Philippine

Department of Eduction
Region XII
Schools Division of South Cotabato
Alunan Ave., Koronadal City

APPLICATION FOR LEAVE

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

3. DATE OF FILING ______________ 4. POSITION__________________________ 5. SALARY _________________

6. DETAILS OF APPLICATION
6. A TYPE OF LEAVE TO BE VALID OF 6.B DETAILS OF LEAVE
Vacation Leave(Sec. 51,Rule XVI, Omnibus Rules Implementing E.O. No.292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(S.O.25,RuleXVI, Omnibus Rules Implementing E.O. No.292) with in the Philippines ____________________
Sick Leave (Sec.43,RuleXVI Omnibus Rules implementing E.O.No.292 Abroad (Specify) ____________________
Maternity Leave (R.A.No.11210/IRR issued by CSC, DOLE and SSS) In case of Sick Leave
Paternity Leave (R.A.No.8187/CSC MC No.71,s1998, as amended) In Hospital (Specify Illness) ___________________
Special Privilege Leave (Sec.21 Rule XVI Omnibus Rules Implementing E.O. No.292) Out Patient (Specify Illness) ___________________
Solo Parent Leave ( R.A. No. 8972/CSC MC No. 8,s.2004)
10-Day VAWC Leave (R.A.No.9262/CSC MC No.15,s.2005) In case of Special Leave benefit for Women
Rehabilitation Privilege(Sec.55 Rule XVI,Omnibus Rules Implementing E.O.No.292) (Specify Illness) _____________________________
Special Leave Benefit for Women (R.A.No.9710/CSCMCNo.25,s.2010)
Special Emergency(Calamity)Leave(CSC/MC No.2,s.2012,as amended) In case of Study Leave:
Adoption Leave (R.A. No.8552) completion of Master's Degree
BAR/Board Examination Review
Others: ____________________________ Other purpose:
Monetization of Leave Credits
Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED: 6.D COMMUTATION
Not Requested
Requested
FOR INCLUSIVE DATES:

(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 Leave Sick Leave
Total Earned
Less this application
Balance

ARLENE L. ALBUNA RANDY D. CONTANG

AO IV - PERSONNEL SECTION PRINCIPAL
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO: days with
pay
Days without pay
others (Specify)

JASMIN P. ISLA
Assistant Schools Division Superintendent

Office/School :
Data of Orig. Appt:
Emplyee No.:
Station Code: