Civil Service Form No.

6
Revised 2020
Stamp of Date of Receipt

Republic of the Philippines

DEPARTMENT OF EDUCATION
DIVISION OF DAVAO DEL SUR
Cor. Plaridel ,Lapulapu Street, Digos City
APPLICATION FOR LEAVE
1. OFFICE /DEPARTMENT OF EDUCATION 2. NAME: (Last) (First) ( Middle)
SHS - DSSF, MALALAG, DAVAO DEL SUR PURACAN GLADYS SARAEL
3. DATE OF FILING: 4/4/2024 4. POSITION: TEACHER II 5. SALARY:
6. DETAILS OF APPLICATION
6.A TYPE OF LEAVE TO BE AVAILED OF 6. B DETAILS OF LEAVE

Vacation Leave(Sec 51.Rule XVI,Omnibus Rules Implementing E.O.No292) In case of Vacation/Special Privilege Leave:

Mandatory/Force Leave(Sec 25.Rule XVI,Omnibus Rules Implementing E.O.No292) Within the Philippines ___________________________

Sick Leave(Sec 43.Rule XVI,Omnibus Rules Implementing E.O.No292) 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 71s1998as ammended) In Hospital (Specify Illness)___________________________

Special PrivilegeLeave(Sec 21.Rule XVI,Omnibus Rules Implementing E.O.No292) Out Patient (Specify Illness)__________________________

SoloParent Leave(R.A. No.8972/CSC MC No 8s2004)

Study Leave(Sec 68.Rule XVI,Omnibus Rules Implementing E.O.No292) In case of Special Leave Benefits for Women:

10-DayVAWC Leave(R.A. No.9762/CSC MC No 15s2005) ( Specify Illness)______________________________________________

RehabilitationPrivilegeLeave(Sec 55.Rule XVI,Omnibus Rules Implementing E.O.No292)

Special Leave Benefits for Women(R.A. No.9710/CSC MC No 25s2010) In case of Study Leave:

Special Emergency (Calamity)(CSC MC No 2s.2012 as amended) Completion of Master's Degree

Adoption Leave(R.A. No. 8552) Bar/Board Examination Review

Others: Other purpose:

Monetization of Leave Credits

Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED FOR: 6. D COMMUTATION
Not Requested

NO. OF DAYS APPLIED / Requested

INCLUSIVE DATES
(Signature of Applicant)
RAYKI A. BUAT, Ph.D. Employee No: 1201300
Principal IV Status/FDS: PERM/01/09/2017
7. DETAILS OF ACTION ON APPLICATION
7. A CERTIFICATION OF LEAVE CREDITS 7. B RECOMMENDATION
AS of For approval ____________________
Vacation Leave Sick Leave For disapproval due to ___________________
Total Earned _______________________________________
Less this application _______________________________________
Balance _______________________________________

JANE C. GARCIA RAYKI A. BUAT, Ph.D.

Administrative Officer II Principal IV

7. C APPROVED FOR: 7. D DISAPPROVED DUE TO:

days with pay

days without pay
others(specify)
 RAQUEL J. CARBOS, Ed.D.
Administrative Officer V

NOTE:
1.1 form6 - CARBOS sig sheet - Leave for 1 to 4 days
Civil Service Form No. 6
Revised 2020
Stamp of Date of Receipt

Republic of the Philippines

DEPARTMENT OF EDUCATION
DIVISION OF DAVAO DEL SUR
Cor. Plaridel ,Lapulapu Street, Digos City
APPLICATION FOR LEAVE
1. OFFICE /DEPARTMENT OF EDUCATION 2. NAME: (Last) (First) ( Middle)
PADADA DISTRICT
3. DATE OF 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(Sec 51.Rule XVI,Omnibus Rules Implementing E.O.No292) In case of Vacation/Special Privilege Leave:

Mandatory/Force Leave(Sec 25.Rule XVI,Omnibus Rules Implementing E.O.No292) Within the Philippines ___________________________

Sick Leave(Sec 43.Rule XVI,Omnibus Rules Implementing E.O.No292) 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 71s1998as ammended) In Hospital (Specify Illness)___________________________

Special PrivilegeLeave(Sec 21.Rule XVI,Omnibus Rules Implementing E.O.No292) Out Patient (Specify Illness)__________________________

SoloParent Leave(R.A. No.8972/CSC MC No 8s2004)

Study Leave(Sec 68.Rule XVI,Omnibus Rules Implementing E.O.No292) In case of Special Leave Benefits for Women:

10-DayVAWC Leave(R.A. No.9762/CSC MC No 15s2005) ( Specify Illness)______________________________________________

RehabilitationPrivilegeLeave(Sec 55.Rule XVI,Omnibus Rules Implementing E.O.No292)

Special Leave Benefits for Women(R.A. No.9710/CSC MC No 25s2010) In case of Study Leave:

Special Emergency (Calamity)(CSC MC No 2s.2012 as amended) Completion of Master's Degree

Adoption Leave(R.A. No. 8552) Bar/Board Examination Review

Others: Other purpose:

Monetization of Leave Credits

Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED FOR 6. D COMMUTATION
Not Requested
NO. OF DAYS APPLIED Requested

INCLUSIVE DATES
(Signature of Applicant)
DELAREY C. FLORENTINO Employee No:
Principal IV Status/FDS:
7. DETAILS OF ACTION ON APPLICATION
7. A CERTIFICATION OF LEAVE CREDITS 7. B RECOMMENDATION
AS of _________________________ For approval ____________________
Vacation Leave Sick Leave For disapproval due to ___________________
Total Earned _______________________________________
Less this application _______________________________________
Balance _______________________________________

RAQUEL J. CARBOS, Ed.D DELAREY C. FLORENTINO

Senior Education Program Specialist II Principal IV
OIC - HRMO

7. C APPROVED FOR: 7. D DISAPPROVED DUE TO:

days with pay

days without pay
others(specify)

LORENZO E. MENDOZA, CESO V

 Schools Division Superintendent

NOTE:

1.1 form6 SDS sig sheet - Leave 30 days up

Civil Service Form No. 6
Revised 2020
Stamp of Date of Receipt

Republic of the Philippines

DEPARTMENT OF EDUCATION
DIVISION OF DAVAO DEL SUR
Cor. Plaridel ,Lapulapu Street, Digos City
APPLICATION FOR LEAVE
1. OFFICE /DEPARTMENT OF EDUCATION 2. NAME: (Last) (First) ( Middle)
PADADA DISTRICT
3. DATE OF 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(Sec 51.Rule XVI,Omnibus Rules Implementing E.O.No292) In case of Vacation/Special Privilege Leave:

Mandatory/Force Leave(Sec 25.Rule XVI,Omnibus Rules Implementing E.O.No292) Within the Philippines ___________________________

Sick Leave(Sec 43.Rule XVI,Omnibus Rules Implementing E.O.No292) 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 71s1998as ammended) In Hospital (Specify Illness)___________________________

Special PrivilegeLeave(Sec 21.Rule XVI,Omnibus Rules Implementing E.O.No292) Out Patient (Specify Illness)__________________________

SoloParent Leave(R.A. No.8972/CSC MC No 8s2004)

Study Leave(Sec 68.Rule XVI,Omnibus Rules Implementing E.O.No292) In case of Special Leave Benefits for Women:

10-DayVAWC Leave(R.A. No.9762/CSC MC No 15s2005) ( Specify Illness)______________________________________________

RehabilitationPrivilegeLeave(Sec 55.Rule XVI,Omnibus Rules Implementing E.O.No292)

Special Leave Benefits for Women(R.A. No.9710/CSC MC No 25s2010) In case of Study Leave:

Special Emergency (Calamity)(CSC MC No 2s.2012 as amended) Completion of Master's Degree

Adoption Leave(R.A. No. 8552) Bar/Board Examination Review

Others: Other purpose:

Monetization of Leave Credits

Terminal Leave
6. C NUMBER OF WORKING DAYS APPLIED FOR 6. D COMMUTATION
Not Requested
NO. OF DAYS APPLIED Requested

INCLUSIVE DATES
(Signature of Applicant)
RAYKI A. BUAT, Ph.D. Employee No:
Principal IV Status/FDS:
7. DETAILS OF ACTION ON APPLICATION
7. A CERTIFICATION OF LEAVE CREDITS 7. B RECOMMENDATION
AS of _________________________ For approval ____________________
Vacation Leave Sick Leave For disapproval due to ___________________
Total Earned _______________________________________
Less this application _______________________________________
Balance _______________________________________

RAQUEL J. CARBOS, Ed.D RAYKI A. BUAT, Ph.D.

Senior Education Program Specialist II Principal IV
OIC - HRMO

7. C APPROVED FOR: 7. D DISAPPROVED DUE TO:

days with pay

days without pay
others(specify)

MARILYN V. DEDUYO
 Assistant Schools Division Superintendent

NOTE:

1.1 form6 ASDS sig sheet - Leave 5 days to 29 days

Please Follow: CSC FORM 6 REVISED 2020 PAGE 1 & PAGE 2
1 FORMS provided by spreadsheet
1.1
1.2
1.3

NOTE:
Rule XVI ORIV BV EO 292

Sec 50

Sec.51

Sec 53
e Follow: CSC FORM 6 REVISED 2020 PAGE 1 & PAGE 2
FORMS provided by spreadsheet
form6 SDS sig sheet - Leave 30 days up
form6 ASDS sig sheet - Leave 5 days to 29 days
form6 - CARBOS sig sheet - Leave for 1 to 4 days

Rule XVI ORIV BV EO 292

Effect of UNAUTHORIZED LEAVE-an official/employee who is absent without approved leave shall
not be entitled to receive his salary corresponding to the period of his unauthorized leave of
absence. It is understood, however that his absence shall no longer be deducted from his
accumulated leave credits, if there are any.

Application for Leave of absence for 1 full day or more shall be submitted on the prescribed
form for action by the proper head of agency five (5) days in advance , whenever possible of
the effective date such leave.( Vacation /Force /Special privilage )Plan leave.

Application for SICK Leave of absence for 1 full day or more shall be submitted on the
prescribed form and shall be filed immediately upon employees's return from such leave.
Notice of absence, however, should be sent to the immediate supervisor. Application for sick
leave in excess of five (5) successive days shall be accompanied bya proper medical certificate.

Sick leave may be applied for in advance in cases where the official or employee will undergo
medical examination or operation or advised to rest in view of ill health duly supported by medical
certificate

In ordinary application for sick leave already taken not exceeding five days, the head of
department or agency concerned my duly determine whether or not granting of sick leave is
pproper under the circumstances. In case of doubt, a medical certificate may be required.