C iv il S e rv ic e F o rm N o .

6 ANNEX A
R e v is e d 2 0 2 0
Re public of the Philippine s
COMMISSION ON AUDIT
Re gional Office No. VIII
Le yte Gove rnme nt Ce nte r, Candahug, Palo, Le yte
Date of Receipt: _______________

APPLICATION FOR LEAVE

1. OF F IC E/DEP AR TM ENT 2. NAM E: (La s t) (F irs t) (M iddle )

NGS Cluster 7 DE GUZM AN ROSARIO RISSA TAN

3. DATE OF F ILING July 21, 2022 4. P OS ITION State Auditor III 5. S ALAR Y P69,963.00

6. DETAILS OF APPLICATION

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

Va c a t io n Le a v e ( S e c . 51, Rule XVI, Omnibus Rule s Imple me nt ing E.O. No. 292) In c as e o f Vac atio n/S pe c ial P riv ile ge Le av e :

M a n d a t o ry/ F o rc e d Le a v e ( S e c . 25, Rule XVI, Omnibus Rule s Imple me nt ing E.O. No. 292) P Within the P hilippine s

S ic k Le a v e ( S e c . 43, Rule XVI, Omnibus Rule s Imple me nt ing E.O. No. 292) Abro a d (S pe c ify)

M a t e rn it y Le a v e ( R.A. No. 11210 / IRR issue d by CS C, DOLE a nd S S S ) In c as e o f S ic k Le av e :

P a t e rn it y Le a v e ( R.A. No. 8187 / CS C MC No. 71, s. 1998, a s a me nde d) In Ho s pita l (S pe c ify Illne s s )

P S p e c ia l P riv ile g e Le a v e ( S e c . 21, Rule XVI, Omnibus Rule s Imple me nt ing E.O. No. 292) Out P a tie nt (S pe c ify Illne s s )

S o lo P a re n t Le a v e ( RA No. 8972 / CS C MC No. 8, s. 2004) In c as e o f S pe c ial Le av e B e ne fits fo r Wo m e n:

S t u d y Le a v e ( S e c . 68, Rule XVI, Omnibus Rule s Imple me nt ing E.O. No. 292) (S pe c ify Illne s s )

10 - D a y VA WC Le a v e ( RA No. 9262 / CS C MC No. 15, s. 2005) In c as e o f S tudy Le av e :

R e h a b ilit a t io n P riv ile g e ( S e c . 55, Rule XVI, Omnibus Rule s Imple me nt ing E.O. No. 292) C o m ple tio n o f M a s te r's De gre e

S p e c ia l Le a v e B e n e f it s f o r Wo m e n ( RA No. 9710 / CS C MC No. 25, s. 2010) B AR /B o a rd Exa m ina tio n R e vie w Othe r

S p e c ia l E m e rg e n c y ( C a la m it y) Le a v e ( CS C MC No. 2, s. 2012, a s a me nde d) purpo s e :

A d o p t io n Le a v e ( R.A. No. 8552) M o ne tiza tio n o f Le a ve C re dits

Othe rs : Te rm ina l Le a ve

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

Two (2) days P No t R e que s te d

INCLUSIVE DATES R e que s te d

July 25-26, 2022
ROS ARIO RIS S A T. DE GUZMAN
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION

As o f

Vacation Leave Sick Leave P Fo r a p p ro va l

T o tal Earne d Fo r d is a p p ro va l d u e to

Le s s this applic atio n

B alanc e

__________________ GREGORIO T. AGUS , JR.

Authorized Officer OIC - Regional Supervising Auditor

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

days with pay
days without pay
others (Specify)

GREGORIO T. AGUS, JR.

OIC- Regional Supervising Auditor
(Authorized Officer)