CivilServiceFormNo.

6Revised2020

RepublicofthePhilippines
Department of Education StampofDateofReceipt
Region X – Northern Mindanao
SCHOOLS DIVISION OF ILIGAN CITY

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

3. DATEOFFILING: ______________________4. POSITION: ____________________________5.SALARY:______________

6.DETAILSOFAPPLICATION
6.ATYPEOFLEAVETOBEAVAILEDOF 6.B DETAILS OF LEAVE

In case of Vacation/Special Privilepge Leave:

VacationLeave(Sec.51,RuleXVI,OmnibusRulesImplementingE.O.No.292)
Mandatory/ForcedLeave(Sec.25,RuleXVI,OmnibusRulesImplementingE.O.No.292) WithinthePhilippines
Abroad(Specify)
SickLeave(Sec.43,Rule XVI,OmnibusRulesImplementingE.O.No.292)
MaternityLeave(R.A.No.11210/IRRissuedbyCSC,DOLEandSSS) IncaseofSickLeave:
PaternityLeave(R.A.No.8187/CSCMCNo.71,s.1998,asamended) InHospital(SpecifyIllness)
SpecialPrivilegeLeave(Sec.21,RuleXVI,OmnibusRulesImplementingE.O.No.292)
SoloParentLeave(RANo.8972/CSC MCNo. 8,s. 2004) OutPatient(SpecifyIllness)
StudyLeave(Sec.68,RuleXVI,OmnibusRulesImplementingE.O.No.292)
10-DayVAWCLeave(RA No.9262 /CSCMCNo.15,s.2005) IncaseofSpecialLeaveBenefitsforWomen:
RehabilitationPrivilege(Sec.55,RuleXVI,OmnibusRulesImplementingE.O.No.292)SpecialLeave (SpecifyIllness)
BenefitsforWomen(RA No. 9710 / CSC MC No. 25, s. 2010)Special Emergency
(Calamity) Leave (CSC MC No. 2, s. 2012, as amended)AdoptionLeave(R.A.No.8552) IncaseofStudyLeave:Completion
ofMaster'sDegreeBAR/
Others: BoardExaminationReview
Otherpurpose:
MonetizationofLeaveCredits
TerminalLeave
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.DCOMMUTATIONNo
t
INCLUSIVE DATES RequestedRequ
ested
(SignatureofApplicant)

7.DETAILSOFACTIONONAPPLICATION
7.ACERTIFICATIONOFLEAVECREDITS 7.BRECOMMENDATIONFora
Asof
pproval
VacationLeave SickLeave
TotalEarned
Lessthisapplication Fordisapprovaldueto
Balance

Administrative Officer II DANILO V. SALVO

PRINCIPAL

7.CAPPROVEDFOR: 7.DDISAPPROVEDDUETO:
dayswithpay
dayswithoutpay
others(Specify)

CELSO C. AFABLE JR.

Administrative Officer V
 INSTRUCTIONSANDREQUIREMENTS
Application for any type of leave shall be made on this Form and to
beaccomplished at least in duplicate with documentary requirements,
asfollows:
1. Vacationleave*
It shall be filed five (5) days in advance, whenever possible, of
theeffective date of such leave.Vacation leave within in the Philippines
orabroad shall be indicated in the form for purposes of securing
travelauthorityandcompletingclearancefrommoneyandworkaccounta
bilities.
2. Mandatory/Forcedleave
Annual five-day vacation leave shall be forfeited if not taken during theyear.In
case the scheduled leave has been cancelledin the exigencyof the service by
the head of agency, it shall no longer be deducted fromthe accumulated
vacation leave.Availment of one (1) day or
moreVacationLeave(VL)shallbeconsideredforcomplyingthemandatory/
forced leave subject to the conditions under Section 25,
RuleXVIoftheOmnibusRulesImplementingE.O.No.292.
3. Sickleave*
 Itshallbefiledimmediatelyuponemployee'sreturnfromsuchleave.
 If filed in advance or exceeding five (5) days, application shall
beaccompanied by a medical certificate.In case medical
consultationwasnotavailedof,anaffidavitshouldbeexecutedbyanapplicant.
4. Maternityleave*–105days
 Proofofpregnancye.g.ultrasound,doctor’scertificateontheexpecteddat
eofdelivery
 AccomplishedNoticeofAllocationofMaternityLeaveCredits(CSFormNo.
6a),ifneeded
 Secondedfemaleemployeesshallenjoymaternityleavewithfullpayintherecip
ientagency.
5. Paternityleave–7days
Proof of child’s delivery e.g. birth certificate, medical certificate
andmarriagecontract
6. SpecialPrivilegeleave–3days
It shall be filed/approved for at least one (1) week prior to
availment,exceptonemergencycases.SpecialprivilegeleavewithinthePhi
lippines or abroad shall be indicated in the form for purposes
ofsecuring travel authority and completing clearance from money and
workaccountabilities.
The head of office shall take full responsibility for the grant of
7. SoloParentleave–7days
It shall be filed in advance or whenever possible five (5) days
beforegoingonsuchleavewithupdatedSoloParentIdentificationCard.
8. Studyleave*–upto6months
 Shallmeettheagency’sinternalrequirements,ifany;
 Contractbetweentheagencyheadorauthorizedrepresentativeandtheemplo
yeeconcerned.
9. VAWCleave–10days
 It shall be filed in advance or immediately upon the
womanemployee’sreturnfromsuchleave.
 Itshallbeaccompaniedbyanyofthefollowing supportingdocuments:
a. BarangayProtectionOrder(BPO)obtainedfromthebarangay;
b. Temporary/Permanent Protection Order (TPO/PPO) obtained
fromthecourt;
c. Iftheprotectionorderisnotyetissuedbythebarangayorthecourt,acertificati
onissuedbythePunongBarangay/
KagawadorProsecutorortheClerkofCourtthattheapplicationfortheBPO,
*Forleaveofabsenceforthirty(30)calendardaysormoreandterminalleave,applicationshallbeaccompaniedbyaclearancefrommoney,propertyandwork-
relatedaccountabilities(pursuanttoCSCMemorandumCircularNo.2,s.1985).
TPOorPPOhasbeenfiledwiththesaidofficeshallbesufficient
tosupporttheapplicationfortheten-dayleave;or
d. In the absence of the BPO/TPO/PPO or the certification, a police
reportspecifyingthedetailsoftheoccurrenceofviolenceonthevi
ctim and a medical certificate may be considered, at
thediscretion of the immediate supervisor of the woman
employeeconcerned.
10. Rehabilitationleave*–upto6months
 Application shall be made within one (1) week from the time of the
accidentexceptwhenalongerperiodiswarranted.
 Letter request supported by relevant reports such as the police
report,ifany,
 Medical certificate on the nature of the injuries, the course of
treatment involved, and the need to undergo rest, recuperation,
andrehabilitation,as thecasemay be.
 Written concurrence of a government physician should be
obtainedrelative to the recommendation for rehabilitation if the
attendingphysician is a private practitioner, particularly on the
duration of theperiodofrehabilitation.
11. Specialleavebenefitsforwomen*–upto2months
 The application may be filed in advance, that is, at least five (5)
daysprior to the scheduled date of the gynecological surgery that
will beundergone by the employee.In case of emergency, the
applicationfor special leave shall be filed immediately upon
employee’s
returnbutduringconfinementtheagencyshallbenotifiedofsaidsurgery.
 The application shall be accompanied by a medical certificate
filledout by the proper medical authorities, e.g. the attending
surgeonaccompanied by a clinical summary reflecting the
gynecologicaldisorder which shall be addressed or was
addressed by the
saidsurgery;thehistopathologicalreport;theoperativetechniqueused
for the surgery; the duration of the surgery including the peri-
operative period (period of confinement around surgery); as well
astheemployeesestimatedperiodofrecuperationforthesame.
12. SpecialEmergency(Calamity)leave–upto5days
 Thespecialemergencyleavecanbeappliedforamaximumoffive
(5) straight working days or staggered basis within thirty (30)
daysfrom the actual occurrence of the natural calamity/disaster.
Saidprivilege shall be enjoyed once a year, not in every
instance ofcalamityordisaster.
specialemergency leave and verification of the employee’s
eligibility to begranted thereof.Said verification shall include:
validation of place ofresidence based on latest available
records of the affectedemployee; verification that the place of
residence is covered in thedeclaration of calamity area by the
proper government agency; andsuchotherproofsas
maybenecessary.
13. Monetizationofleavecredits
Application for monetization of fifty percent (50%) or more of
theaccumulated leave credits shall be accompanied by letter
request totheheadoftheagencystatingthevalidandjustifiablereasons.
14. Terminalleave*
Proof of employee’s resignation or retirement or separation from
theservice.
15. AdoptionLeave
 Application for adoption leave shall be filed with an
authenticatedcopyofthePre-
AdoptivePlacementAuthorityissuedbytheDepartmentofSocialWel
fareandDevelopment(DSWD).