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Form 6

This document is a civil service form application for leave from the Department of Education in the Philippines. It contains sections for the applicant to provide their name, position, salary and type of leave being requested. In this case, the applicant is requesting 1 day of dental appointment leave on April 11, 2023. The form also includes sections for certifying the applicant's leave credits, recommendations on the application, and space for approval or disapproval with the signature of the approving official.

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Chesee Ann Sopera
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79 views2 pages

Form 6

This document is a civil service form application for leave from the Department of Education in the Philippines. It contains sections for the applicant to provide their name, position, salary and type of leave being requested. In this case, the applicant is requesting 1 day of dental appointment leave on April 11, 2023. The form also includes sections for certifying the applicant's leave credits, recommendations on the application, and space for approval or disapproval with the signature of the approving official.

Uploaded by

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

6
Revised 2020

Republic of the Philippines


Department of Education Stamp of Date of Receipt
DIVISION OF ORIENTAL MINDORO

APPLICATION FOR LEAVE


Employee No:

1. OFFICE/DEPARTMENT 2. NAME : (Last) (First) (Middle)


DEPARTMENT OF DRIS CHESEE ANN
EDUCATION SOPERA
APRIL 11, 2023 TEACHER III 31, 320.00
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
Dental Appointment
_____________________________________ Terminal Leave

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


1 DAY
________________________________________ Not Requested
INCLUSIVE DATES Requested
APRIL 11, 2023
________________________________________
(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 ___________________________________________

NORIE FE F. MALCON ___________________________________________


LORIFE Y. NOVENARIO
School Head/District Supervisor
HRMO II

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


_______ days with pay _______________________________________
_______ days without pay ___________________________________________
_______ others (Specify) ___________________________________________

RAFAEL G. MANALO, Ph.D


Asst. Schools Division Superintendent
* for teaching & Non Teaching- 1-14 Days

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