Civil Service Form No.

6 ANNEX A
Revised 2020
Republic of the Philippines
STAMP OF DATE RECEIVED
Department of Education - Schools Division of Koronadal City
Jaycee Ave. Corner Rizal St., Brgy. Zone IV, Koronadal City, South Cotabato

APPLICATION FOR LEAVE

1. OFFICE/SCHOOL: 2. NAME: (LAST) (FIRST) (MIDDLE)
SDO KORONADAL BALILA EILEEN M.
3. DATE OF FILING: 4. POSITION: 5. SALARY: (Monthly)
ADAS-II

6. DETAILS OF APPLICATION
6. A. TYPE OF LEAVE: 6. B. DETAILS OF LEAVE:
q Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of vacation/ Special Leave:
Mandatory/ Forced Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O.
q No. 292) q Within the Philippines
q Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) q Abroad (Specify) _____________________
q Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS)

q Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended) In case of Sick Leave:
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No.
q 292) q In Hospital (Specify Illness)
q Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004)

q Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) q Out Patient (Specify Illness)
q 10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005)
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No.
q 292)
In case of Special Leave Beneifts for Women:
q Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) (Specify Illness)
q Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended)

q Adoption Leave (R.A. No. 8552 In case of Study Leave:

q OTHERS: q Completion of Master's Degree
2 days CTO TO COC q Bar/ Board Examination Review
Other purpose:
q Monetization of Leave Credits
q Termination Leave

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

q Not Requested
INCLUSIVE DATES q Requested

(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION

7. A. CERTIFICATION OF LEAVE CREDITS 7. B. RECOMMENDATION

As of q For Approval
q For Disapproval due to __________________
Vacation Leave Sick Leave _____________________________________
Total Earned _____________________________________
Less this application _____________________________________
Balance

FAIZAL B. MACASAYON DANILO C. ABANIL

Administrative Officer IV/ HRMO SGOD CHIEF

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

1 Day/s with pay _________________________________

_____ Day/s without pay _________________________________
_____ Others (Specify) _________________________________

CRISPIN A. SOLIVEN JR., CESE

Schools Division Superintendent
(Head of Office)