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Omar Form6 Teaching Personnel r.2020

The document is an application for leave form from the Department of Education in the Philippines. It requests information such as the applicant's name, position, type of leave being applied for including vacation leave, sick leave, and others. It provides spaces for the number of working days applied for, certification of leave credits, and approval or disapproval of the application.

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Katherine Hinampas Benigno
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29 views1 page

Omar Form6 Teaching Personnel r.2020

The document is an application for leave form from the Department of Education in the Philippines. It requests information such as the applicant's name, position, type of leave being applied for including vacation leave, sick leave, and others. It provides spaces for the number of working days applied for, certification of leave credits, and approval or disapproval of the application.

Uploaded by

Katherine Hinampas Benigno
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Civil Service Form No.

6 ANNEX A
Revised 2020

Republic of the Philippines


Department of Education
REGION X - NORTHERN MINDANAO
DIVISION OF MALAYBALAY CITY

APPLICATION FOR LEAVE


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

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. No. 292) In case of Vacation/Special Privilege Leave:
Mandatory/Forced Leave(Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Within the Philippines __________________________
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) 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. 71, s. 1998, as amended) In Hospital (Specify Illness) _____________________
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Out Patient (Specify Illness) ____________________
Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004) _____________________________________________
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Special Leave Benefits for Women:
10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005) (Specify Illness) ________________________________
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) _____________________________________________
Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) In case of Study Leave:
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Completion of Master's Degree
Adoption Leave (R.A. No. 8552) BAR/Board Examination Review
Other purpose:
Others: Monetization of Leave Credits
_____________________________________ Terminal Leave
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION
________________________________________ Not Requested
INCLUSIVE DATES Requested
________________________________________
Signature of Applicant
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 ___________________________________________

GUIA MA. G. VILLAHERMOSA ___________________________________________


Administrative Officer IV Authorized Officer
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:
_______ days with pay _______________________________________
_______ days without pay ___________________________________________
_______ others (Specify) ___________________________________________

ALIENA S. DAJAY, PhD, CESE


_________________________________
Asst. Schools Division Superintendent

Address: Sayre Hi-way, Purok 6, Casisang, Malaybalay City


Telefax No.: 088-314-0094; Telephone No.: 088-813-1246
Email Address: [email protected]

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