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Jeepartment of €butation
REGION VIII - EASTERN VISAYAS

May 12, 2021

OFFICE MEMORANDUM
NCO 0 0 1 8 4s. 2021
To: ALL DEPED REGIONAL OFFICE VOl EMPLOYEES

REVISED APPUCATION FOR LEAVE (CS FORM NO.6, REVISED 2020)

1. Per Civil Service Commission Memorandum Circular No.5, s. 2021, attached is the
revised Application for Leaveprescribed to be used by all government employees.

2. Immediate dissemination of and strict compliance with this Memorandum are desired.

MA. GEM~/o LEDESMA

...( Regional Directo~

AD-PS-COZ

DepEd R08 ATA-F16 (CY2018-v03-rOO) Page 1 of 1

Government Center, Candahug, Palo, Leyte
(053) 323-3156 I region8@deped.gov.ph
"~~M'" ISO 9001:2015 Certified
 For 0Ms1on Otle/s

llepaillit oftbt ~bilippin~

~tp&ttmttll or «bucaUoll
REGION VII- EASTERN VlSAYAS

APPLICATION FOR LEAVE

1. OFFICEJOEPARTMENT 2. NAME: (last) (First) (Middle)

3. DATE OF FILING 4. POSITION 5. SAlARY ..

6. DETAILS OF APPLICATION
6A TYPE OF LEAVE TO BE AVAILED OF 6.B DETAILS OF LEAVE
o Vacation Leave (Sec. 51. Rule XVI. Omnibus Rules ImplementingE.O. No. 292) In case of VacationlSpecial Privilege Leave:
o MandatorylForced leave(sec.25. Rule XVI. Omnibus Rules Implemenling E.O. No. 292) o Within the Philippines
o Sick leave (Sec.~. RtAeXVI. Omnibus Rules Implementing E.O. No. 292) o Abroad (Specify)
o Matemity Leave (R ....No. 11210 11RRissued by esc,DOLE SSS) and In case of Sick Le8ve:
o Patemity Leave (R.A. No. 8187 J CSC Me No. 71. s. 1998. asamended) o In Hospital (Specify Illness)
o Special Privilege Leave (Sec 21. Rule XVI. Omnibus Rules Implementing E.O. No. 292) o Out Patient (Specify Illness)
o Solo Parent Leave (RA No. W2 J CSC Me No.8. s. 2004)
o Study Leave (Sec. 68. Rule XVI. Omnibus Rules Implementing E.O. No. 292) In case of Specia/ Leave Benefits for Women:
o 1G-DayVAWC Leave (RA No. 9262J escMe No. 15. s. 2005) (Specify Illness)
o Rehabilitation Privilege (Sec. 55. Rule XVI. Omnibus Rules Implementing E.O. No. 292)
o Special Leave Benefits for Women (AANo 9710 J esc Me No. 25. s. 2010) In case of Study Leave:
o Special Emergency (Calamity) Leave (cseMe No. 2, s. 2012, as amended) o Completion of Master's Degree
o Adoption Leave(RA. No. 8552) o BARlBoard Examination Review
Other purpose:
others: o Monetization of Leave Credits
o Terminal Leave
6.C NUMBER OF WORKING DAYSAPPLIED FOR 6.0 COMMUTATION
o Not Requested
INCLUSIVE DATES o Requested
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECot£1ENDATION

As 01 o For approval
Vacation Leave Sick Leave o For disapproval due to
Tota/Earned
Less this application
Balance

EVA D. ROSALES BEBIANO I.SENTILLAS.CESOV

Administrative Officer V Schools Division Superintendent
OIC-Q1Ik:e of the Assistant Regiooal Director

7.C APPROVED FOR: 7.0 DISAPPROVED DUE TO:

days with pay
days without pay
others (Specify)

MA. GEMMA MERCADO LEDESMA

Regional Director
allil ~rv~ Form No. 6
R~viHd2020 • Foroth~r~mployres
•
)\tpublit of tl.It ~bilippintg
~tpartmtnt of 4tbutation
REGION VTII- EASTERN VTSAYAS

APPLICATION FOR LEAVE

1. OFFICEIDEPARTMENT 2. NAME: (Last) (First) (Middle)

3. DATE OF FILING 4. POSITION p

5. SALARY

6. DETAILS OF APPLICATION
6A TYPE OF LEAVE TO BE AVAILED OF 6.B DETAILS OF LEAVE

o Vacation Leave (Sec51 Rule XVI, OmnDus Rules Implemenllng E 0 No 292) In case of Vacation/Special Privilege Leave:
o Mandatory/Forced Leave(Sec25, Rule XVI, OmnDus Rules ImplemenbngE 0 No 292} o Within the Philippines
o Sick Leave (Sec43, Rule XVI, OmnDus Rules Implemenhng E 0 No.292) o Abroad (Specify)
o Maternity Leave (R A No 11210IIRR ISsuedby CSC, DOLE and SSS) In case of Sick Leave:
o Paternity Leave (RA No 8187/CSC Me No 71, s 1998. asamended) o In Hospital (Specify Illness)
o Special Privilege Leave (Sec21, Rule XVI OmnDus Rules ImplemenbngE 0 No 292) o Out Patient (Specify Illness)
o Solo Parent Leave (RANo ~nI CSC Me No 8, s 2004)
o Study Leave (Sec68, Rule XVI, OmnDus Rules Implemeobng E 0 No 292) In case of Special Leave Benefits for Women:
o 10-Day VAWC Leave (RANo.9262I CSC Me No 15,s 2(05) (Specify Illness)
o Rehabilitation Privilege (Sec55, Rule XVI. Omnibus Rules ImplementIngE 0 No 292)
o Special Leave Benefits for Women (RA No 9710 I CSC Me No 25, 2010) S In case of study Leave:
o Special Emergency (Calamity) Leave (CSC Me No 2, 2012. as amended)
S o Completion of Master's Degree
o Adoption Leave (R A No 8552) o BARlBoard Examination Review
Other purpose:
Others: o Monetization of Leave Credits
o Terminal Leave
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.0 COMMUTATION
o Not Requested
INCLUSIVE DATES o Requested
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7 A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As 01 o For approval
Vacation Leave Sick Leave o For disapproval due to
Total Earned
Less this application
Balance

EVA D. ROSALES
AdministrativeOfficerV DivisionChief

7.C APPROVED FOR: 7.0 DISAPPROVED DUE TO:

days with pay
days without pay
others (Specify)

BEBIANO I. SENTIUAS, CESOV

SchoolsDivisionSuperintendent
OIC-Officeof the AssistantRegionalDirector

INSTRUCTIONSAND REQUIREMENTS
Application fa' IIny type of leave shall be made on this Form lind 12...1!1
lljComplilhed at least in duplicat. with documentary requirements, as
foIows:
1. Vacation leave'
It shall be filed fiw (5) days in IIdllance, whenever !)OSSilIe, of the
effectve date of such leave. V.cation leave withil iIthe PhiliWines or
abroad shaH be indic8ted in the form b' p~ of securing travel
authai1y and completing cle8ranca tom money and work
8CCOunlllbililies.
2. lIandatorylForcedleave
Annual fNe.day VllQltion leeve shel be forfeited if not taken dlJ"ing the
year. In case the scheduled leave has been cancelled in the exigency
of IIle savice by the heed of agency, it shell no longer be deducIed from
the ac:cumulated vacation leave. AlIlIilment of one (1) day or more
Vecation Leeve (VL) shall be considered for complying the
mendebylforced leave subject., the conditions under Section 25. Rule
XVI of the Omnibus Rules Inl>lementing E.O. No. 292.
3. Sicklea ... •
• It sIlIIII be filed irrnediately upon ~Ioyee's relUm from sucflleeve.
• If filed in advance or exceeding five (5) days, application shall be
IIOCXIlllIInied by a medical certificate. In case medical consultation
was not alllliled of, an ellidavit should be executed by an applicant.
4. Maternity I..... • -105 days
• Proof of pregnancy e.g. ulnsound, doc1or's certificate on the
expected dale of deliwly
• AIlcompIished Notice of Allocation of Maternity Leeve Credits (CS
Form No. 611),if needed
• Seconded female ~yees shall enjoy maternity leave with full pay
in the ~ agency.
5. Paternity leave - 7 days
Proof of chOd's delivery e.g. bi1h certificale, medical certificate and
marTiage oonhct
6. SpecialPriviklge leave - 3 days
It shan be fiIed/IIpproIIe fa' at least one (1) week prior ., allllitnenl,
except on emergency cases. Special privilege leave withil lIle
Ph_inas or IIbroad shan be indicated in the form b' purposes of
securing Ir8vellulhorily and completing clearance tom money and work
lCCIOuntabilities.
7. Solo PaftIIll ..... - 7 days
It shall be filed in adVance or whenever possiIle fiw (5) days beb'e
going on such leave with updated Solo Parent IdentiflCltion Cerd.
8. study leave" - up to 6 months
• Shan meet die agency's infernal re~irernents, if any;
• Contrad between the agency head or aulhorized representative and
the employee concerned.
9. VAWCleave-10days
• It shall be filed in advanca (J' imledai3ly upon the women
employee's rehrn from such leave.
• Itshall be aCCOlll'lnied by any 01the followilg ~ng documents:
•. Barangay ProUlction Order (BPO) obIained tom the bllrangay;
b. TemporaryIPermanent Protection Order (TPOIPPO) obtained fi'om
the court;
c. If the protection order is not yet issued by the barangay or the court.
a certification issued by the Punong 8a'angayl1(egawad or
ProsecuD' or the Clerk of Court lhat the application for lIle BPO,
• For leave d IIbseooe for thity (30) call1ncK days or more and terminal leave, eppIication shall be IICCOII1P8nied
¥!It-t!!!!!ted I!CCOIII!I!biI! (pll'$Ullnt to esc Memorandum Ci'cuIar No.2, s. 1985).
•
TPO or PPO has been filed with the said office shall be sufficient
III support the application for lIle len.<fay leave; (J'
d. In the absence of the BPO/TPOIPPO or the certification, I police
report specifying the details of the occurrence 01 violence on the
victim lind a mecical certificate may be considered, at lIle
discretion of the immedate Sl4)8Nisor of the woman ~
concerned.
10. Rehabilitation leav.· - up to 6 month.
• Application shall be made within one (1) week tom the time of IIle
accident except when a longer period is warranted.
• Leller request supported by relevant reports such as the pob
report, if any,
• Medical certificate on the nature of the injlries, the COIJ"se of
treamen! involved, and the need ., undergo rest, recuperation, and
rehabilitation, IS the case may be.
• WritIen OOIlCUlTenc8 of a government physician should be obtained
relative to lIle recommendation for rehabilitation if the attencing
physician is a private prac1itioner, particularly on the duration of the
period of rehabiltation.
11. SpecI.1 tea... benefit. for women· - up to 2 month.
• The application may be filed in advance, that is, at ten live (5) days
prior to the scheduled date of !he gynecological surgery that wi.
be
undergone by the employee. In case of arnergency, the application
for speciel leave shall be filed mmediately upon ~yee's relUm
but during confinement 1I1eagency shall be nodied 01said surgery.
• The application shall be a~nied by II medical oertiIicate filled
out by the proper melicel authorities, e.g. the attending surgeon
accompanied by a clinical summary retecting the gyneooIogical
disorder whicfl shall be adctessed or was adctes$ed by the said
wgery; the himpathological report; the qlerUtive technique used
for the wgery; the duration of the surgery inclldng the peri-
operative period (period of oonfinement around SlJ"gery); as well as
the arnplo~ estimated period of recuperation b' the same.
12. Special Emergenc:y (Calamity) IllVe - up to 5 days
• The special emergency leave can be applied fa' a maxinum of live
(5) straight Mlrking days (J' staggered basis within tlity (30) days
from the actual occurrence of the natlJ"al calamilyldisas'ler. Said
privilege shall be enjoyed once 8 year, not in every ils1lInce of
calamity or disaster.
• The head of ol!ioe shall lake full responsbHity for the grant of ~al
emergency leeve and verification of the employee's eligibilty III be
granted thereof. said llerification shall inc:klde: IIlIlidation ofplaoe of
residence based on IaIBst availab1e records of lhe affeded
~; verification that lhe pIaoe of residence is covered in the
declaration of calM1ity area by the proper government agency; IIIId
such olher proofs as may be necessary.
13. MonlliZlltion of Ie..,e credits
AppliClltion fa' mCMletization of Iif\y percent (50%) or more of Ihe
ecaJmulaled leaw creats shaH be accanpanied by IetIer' request t)
the head of the agency slating the IIlIld and justifiable reasons.
14. Tarminalleav.·
Proof 01 employee's resignation or retrement or separation tom l'Ie
service.
15. Adoption Leave
• Application for adqltion leave shall be filed with an authenticated
copy 01 the Pre-Adoptive Placement Authority issued by lie
Depat1menl of Social WeIfln Ind Development (DSWO).
by a clenrICBfrom!!lO!l!ll' prooerty ani