‘Republic of the Philippines Department of Cducation REGION XI Schools Island Garden City of Samal Division Memorandum No. 43 ee Series 2021 JUN 3 9. 2001 New Application for Leave Form (CS Form No. 6 Revised 2020) To: Assistant Schools Division Superintendent Chief, CID and Acting SGOD Chief Public Elementary School Heads Teaching and Non-Teaching Personnel This Division Date: _June 30, 2021 1. This is to inform the field on the issuance of Civil Service Commission Resolution No. 2100020 promulgated January 7, 2021 prescribing the revised Application for Leave (Civil Service Form No. 6, Revised 2020) with the Instructions and Requirements to be use by all government employee. 2. In connection thereto, attached in this memorandum is the New Application for Leave Form which shall be strictly use in schools and offices in DepEd Island Garden City of Samal effective July 1, 2021. 3. Please be advised that application for leaves of not more than sixty (60) days shall be signed by the Assistant Schools Division Superintendent while application for leaves of ‘more than sixty days shall be approved by the Schools Division Superintendent, 4. For easy reference, the softcopy of the New Application for Leave Form shall be uploaded in the official group chat of DepEd IGACOS ManCom. 5. Widest dissemination of this memorandum is earnestly desired. 6. For information, guidance, and strict compliance. WINNIE fs TOON, CESO VI Assistant Schools Division Superintendent Officer In-Charge Office of the Schools Division Superintendent Inc: CSC Resofution No. 2100020 5, 2021 WEB/djd06302021 ge te SFC JUN 2021 » Contact No.: 917-503-9772 Address: Sitio Pain Bry. Pefopat,Destrict and Garden iy ofSamad 110) Email Address: samalcity@deped.gov.ph °Republic of the Philippines ent of Education jaro otOnetRengt Sitio Pasig, Penaplata, IGACOS L “— APPLICATION FOR LEAVE [1. OFFICE;DEPARTMENT 2 NAME: (Last) (First) “qaiddie) ls. DATE OF FILING 4, POSITION 5, SALARY 6. DETAILS OF APPLICATION [eA TYPE OF LEAVE TO BE AVAILED OF Cl Vacation Leave (is, ub, One us rlnsrtng 0. No 28 Di MendatoryiForced Leaver 25, eX, Cont Re inprery £0, N22) Sick Leave (se. Aue XV, is Rus est 0. N02) Di Maternity Leave ma ne 1210/1 dy CSC, OLE e555) Cl Paternity Leave gs Noe SCM Wo. 7,5 199 a ens) D Special Priviege Leave es 21, arr, Orbs Rats sorta 0.22; Cl Sole Parent Leave RNs 972/050 Me No.8 209 Dl Study Leave fe, ctu a gamerrg £0. N22), Ci t0-Day VAWC Leave (eno 082/080 MW. 15,6 200) C1 Rehabittation Privilege (Sc ex”, Ont iromeg 0.22) LL Special Leave Bonefite for Women (RAN® 910/¢86 MH. 2.5 200), Ci special Emergency (Calamity) Leave (2s Uc Na 2 2012s ams 1 Adoption Leave eA No. 85) Others: [6.8 DETAILS OF LEAVE Incase of Vacation/Special Priviloge Leave: [within te Phiippines (Cl Atroad «Speci {In case of Siok Leave: Cin Hospital (Specty ness) Tout Patient (Specity Ines) eSSSsSSS= In cose of Special Leave Benefits for Women: (Specty ness) In c9¢0 of Study Leave: Ci completion of Masters Degree (C1 BARVBoard Examination Review ther purpose: Ci Monetization of Leave Credis, Di Terminal Leave [aC NUMBER OF WORKING DAYS APPLIED FOR INCLUSIVE DATES 7. DETAILS OF ACTION ON APPLICATION [7.A CERTIFICATION OF LEAVE CREDITS [aD COMMUTATION Not Requested Ci Requested Signature of Applian) [7.8 RECOMMENDATION Aso _ For approval Vacation Leave: ‘Sik Leave C1 For disapproval due to Total Eamed ‘Less this application Balance Hathorized Ofieer) 7 ‘(Authorized Officer) a a 17. APPROVED FOR: days with pay days without pay others (Specify) WinME: 7.D_ DISAPPROVED DUE TO. ‘IC - Schools Division SuperniendntINSTRUCTIONS AND REQUIREMENTS ‘epleatn fay pe of ove sal be made on hs Form an 19 be sczomlched a ae! i dupleate wih conor requremet, St ‘oto ‘ecation ave Taha be fled five (5) days in adtance, wheres pose, of he ‘tec dat of suc ave. Vacaon eave wn te Pipes ‘bron shale lnscate in frm for paps of bean Wave Subory and” completing coarace, fan money and. Work Scinbles 2. MandetonyForced ave ral veda vacation lav shall be aod retaken dung ho Year note te sctedled ave ha ean canal nto enigndy {th carienbytheead of pec), ogo be dodo ton the scrimietedvaoton lave, "Arama of tne () doy of re Vaca ‘Une (Wt) shal be cod To comple the ‘andsonlocesanvebjectshecenstons unde Serbo 75,6 Jeol te Omibus Puls trplomerng 0. No. 292 2. Sekteoer +1 sal bofled ined upon gloom fom such ao 1 ilogf aosance o mesg fue (6) cays, appaton sal be ‘oar ya deal afc case medal arson onl aval of, 1 aia sould be eco by on applet. 4. Mary love’ 108 oye Prost of pregency 29. ubesound, docs caricate onthe (paced dae ate + Koeomplhed Nbc of Aectin of Maley Leave Cas (CS Fart. 6), ete + Sezaeded female enpleyons Sal joy matey lowe wh alipay Paternity leave 7 days roo of chids delivery eg, birth coca, ma aren conve Special Prope eave 3 aye [Coal bo elapgroved 1 a eat oe (1) wosk roo avant, ‘xcopk on ‘onapercy casos, Spel pivioge leave wa be Pres er atvod sal be nda i he or fr pupae ‘surg roel aur adconpetrg cerace fom motay a Wor. secaumtbites, cl cata and 7 Solo Parent eave =7 dys [fol be fe radiance or whenever poste te (5) ay belore ‘3 such av wh pda Slo Pare ieion Ca Study eave to 6 onthe + Shat est ne apne hal requirement, ay * Contract beeen te agency Nad or utes poses sr ‘he erpoye emcred. 8. VAW lave 10 dye It shal be fed In advance or mnadlly upon the woman Spy atom fan sch eae «shale acoarpniaty ary flour apering document: «2 Barangay Protacon Or" 20) chan am he Braga 3 Terpeeyamaren ras Git OPPO cbr on «Ite poeton erst ative bythe barangay athe cout 4 ceteain ved by te Pung. SasrgayKagoqad.c Prosocur ot be Cr of Coutt h apleaon fre BPO, “PO or PPO ha oan fled wth sc ofc shat be ure ‘expe teapot aha ye 4 n ne teens te SPOMTPOIPFO ore eaten,» pce reper spag the elas of neasrnceo leno eo am end & edcal create may be conde, at he ‘Sarton ofthe erode superar of fe woman enpyeS tencemed 10, Retabitation ave —up to 6 months = hopisian shal bs mat win oe) wot Kom he ino ‘esr ox wna oat po warants + Leer request suppard by lover apr suchas tho ples ‘out ry, + Moe carieate 0 th nakx0 of te nes, te couse ok eabent meted ord naad © Undego ret repent reiaton, re eto may be, + Ween cocirrence ofa gorermant hyn shouldbe clined reaive ta tbe rconmeraon or rehab # te ser Diyisan a pate preciiorer, pubs neds a ferod teat, 11. Spec eee benefit for women’ =o o monte = Theappteatin may te isn aan, hal aa 0 (9) ys arte sows doe ete gyresoogeal sumer at ibe Undone by Be amployes. neasaof regency, fe apaleaton {er spect eee sl be le inca upon engayes ren buts conineren te agency al be noted os sg ‘The appleain al aczormpatod by a mada crits es ‘ou by be proper medcalsdharis, 49. be sedng ampere ‘reorpann by 2 ral imma teary De gynecsopeal Cordr when chal ba area or wae arose bythe 8a ‘urge be nsepancice report opera ting wed terne sagen, be dain of be suay ching be pe (perabve pared pod of canara oun gery 98 wel ‘io empljee extras prod ol rsipraton ab came 12, spec Emergency (Clay) love —up to Saye "The spcal emerge lav cn bo appl ea maximum 0 (9) staph wont days a sagged bass main tty (30) ye fom be tena osarence of Be natiral ears, Sod Divloge shal be eoje once ya, no m ey ance OF fant or asa + Thaheadet foe sat tke fu responsi rte grant ene teerpncy leave and verte th engoys chil obo ‘ated Der. Sal acon shal cue vleson cleo Feige based on etek alae Toss of to. efeded ‘plres: vor tat he poe of iene fe covered he Seckaraton of etary sea e pope gover agen and ‘Ser cne pote uy beens, 1% Manotztion of ave cris ‘epcatan for enwtzaan cf fy percent (0%) o more of he ‘muta ooo sets sabe seconpmid by le rou ‘eed of apc tn ha va ral cen 14 Terminal nave’ Poa ef epaye' resignation or tram sparton tom he 18 Adoption Leave * Aeleton acon ave chal be ke wh a ater ‘2or of te PreAdooive Placement thor ested by tha Depatnent ot Sol Wer and Deron (OSD), * Faron ot aban try (0 candy cnr tera lan, lca lle arpa by euceFeR.ner ney nd edo wot sua DSC Menennsan Gear 286),(vt Serie Form No sve 200 Z Republic ofthe Phitipines 1 Deparinont of Education Co | ; Stio Pasig, Pehaplata,IGACOS | APPLICATION FOR LEAVE [ OFFIGE/DEPARTWENT 2 NAME: (ond sb wie) s. DATE OF FIUNG 4. POSITION s SAARY ‘6. DETAILS OF APPLICATION [SA TYPE OF LEAVE TOBE AVAILED OF Je DETAILS OF LEAVE Dl Vacation Leave (sec, 51, Rte 1, rnbus Ras implanting £0, No. 292) In case of Vacation/Special Privilege Leave: C Mandatory/Forced Loaves. 2 7, Orn Ruks emerge 0.0222, |] Within the Philippines, D Sick Leave (Sec. 63 Fade XV, Omnibus Ralesimplemerting £0. Ho. 282) TD Abroad (Spectty) Cl Maternity Leave (A No. 11210/ IRR sswd by CSC, DOLE and S88) In case of Sick Leave: C1 Paternity Leave (RA no. 6187 /CSCMC No. 71,5. 1998 asamendes) C1 in Hospital (Specify tines) D Special Privilege Leave (Sec 21, Rue”, Omrtus le Implementing 0. No. 22) C Out Patient (Specify lines) 1 Soi Parent Leave mais 2 /3:4e Ne 629 — 1 Study Leave (sec. 88, Ruse X07, Omeibus Rus rplementing E.0, No, 282) In case of Special Leave Benemts for Women: (Cl 10-Day VAWC Leave [RA Wo, 9252/69 MC No. 18,5, 008) (Specify lines). D. Rehabilitation Privilege (Sec. $5, Rue x1, Omnibus Fuses implementing 0, No. 252) I Specil Leave Benefits for Woman pas 19/30 No. 20) Incase of Study Leave Special Emergency (Calamity) Leave (C80 MC No. 2.5. 2012, as amended) (C Completion of Master's Degree: Adoption Leave mA wo, 8552) (C1 BAR/Board Examination Review ther purpose: Others: Ci Monetization of Leave Credits —,-![/>YK ,T -_,H__———— CO Terminal Leave [Sc NUMBER OF WORKING DAYS APPLIED FOR lap GomasTATON i Not Request INCLUSIVE DATES Liroqected —Bianatire of Appcany 7. DETAILS OF ACTION ON APPLICATION I-A CERTIFICATION N OF LEAVE CREDITS f.8 RECOMMENDATION Aso a = Fr approval Tota Ea ve [sic Teave: CiFerdisapprovalduoto Taishi appenon Balance Teaorzed Oa 2 ‘(Authorized Officer) 1.6 APPROVED FOR. ee 7.0 DISAPPROVED DUE TO. TS eays winout ay eee ‘others (Specty) areca eee EMMA. CAMPOREDONDO, CESE_ 7sesiant School Dison Superhtendnt[ INSTRUCTIONS AND REQUIREMENTS ‘hal b mace on his Form and to be ‘epson ay pe ae oat ‘eh Samer reqararat 8 {fo sonmolaad oon Jove. Avant fcr (1) yo mee caton Lame (Wt) al be coded for camphing he ‘Mvontnced ime abjects ha coins ge Scion 25, Sata be Ons Fie implore 0. Ne, 22. 2. Sekleee" hale ic kmail upon onlays etm for such ave 1 ies aeyone ces fro () cvs, pplon Sal be ‘sponooned by a modal cede, Incase model consular ‘Sento oeted on aia sous be exerted by an evict 4 atoraiy eave? = 105 ye Proof pgnancy ©. uloound, ‘expe dae of eer : Notca of Aocaon of Mae Leave Cris (CS Fr No a neodod = Soned fale empyocs shal oy matty ave win At ay sta vepien age. ecore catate one 5 Paar lave 7 dye Prof eds dey 00 tape etek ‘Spgca Prvoge lave =3 dy PPhat be Rotepgroved feast oe (1 wok pro ment, acpl on emerpency cane. Syeda! pvoge lane win Philos or ston sel be indexes i be fm fr pues of Srewytoelovbsy an comping dearer money md otk 1, Solo Parentaave—7 aye Tata bs fg aan o whenever posse fv (6) days bore {hing on sch bove ih pated Glo Pret dentonion Coe Study ave upto 6 onthe = Salon he agony neal require fay 1 Gantt betes ager head or ain arene and ‘e enpayee cncamet ith carol, medial cae end wire Me ’ sn mt on vn EES ese ceeeeemrevnenme errant Se er, «ee rsemmmmcyesuenyerenn ts etostan ous by “he Pane end ot Frente Gok tC et Be etcarn 2 BP, " 2 8 * “0 PPOs bow He wn he i fica ict Tosser enn te ay me Stren STPOTS oon nema es ‘pesig re bal de czars ot tt tt cant ayo ciel, Be eo md epee of bs wanes eB Somes ehaation eee — vp 2 moths pte sab rio win one 1) wook Ka te ie ert sop when along: pets wari «Ther ramet supped by rover reper eo a 0 pn ‘apo Fry, = RES etc on po ary fe in, he xe cee ere anh en arg Ps YP =bo od ‘arbiaton on bo cv nay « Wtbn conser open’ pyscn shoud be ned (Wome wh foxonrnatn for ebaiaten Be atoning fryseon apne recon para on te dation ee Feros ef hots. ‘Special eave benef for womest upto 2 months Pik apleatin yb on advan, ats tate (8) 8 lect be somatod dae of he gece suber a i Prgrron byte orp. cane of erespecy, fe appcton ‘Gestot ne sate ed orc wn egy re” 1 if { i { i ‘Special Emergency (Calamity) leave up 0 8 days Pipe spa! enero lave cn be eped fe mira oe (Geter wenn days or sagpee baa win iy C2) days fon he acl coarence f fe rata lariat, Sot Prvege shal be enoyo ones a year, non every sone of falanty or dss. + Theoa fon dat kel respon rth grata pei ‘resyoncy eave and-efton le enor ly tbe (Pare beret. Gall erate chal nae. vaso pace of Fesicence osed ov ted malabe ecods of te. sects tenpyes verona ho pace of eserce i covered in the ‘etraton ofc ara by Be proper ovement gery: 8 ‘sh har roc as 2a be ees. onatization of ave cred Aglaton for menazatan cf My percent (0%) or more of te ‘uel eo ced be sesame ye request te hod be agncy lt he va ana etal sen. Temata oF grat oreraent | lyon rt caperatn tom ne ‘Adoption Leave ‘= Ropleaton for odepon lea cal be fed wih an auhonfotd by of tw PreAdonive Poona. Auerty taued Oy te Depatnen ct Sock Wer and Beeopment OSA) "Far eogaf abn iy (0) ade Syn ornare anemia ne, pice shal be ezaneriedy 8 kc om omy oe and wed acres riot OSC Mra CrcdrNe. 22 185, yes