Civil Service Form No. 6
Revised 2020
Stamp of Date of Receipt
Republic of the Philippines
DEPARTMENT OF AGRICULTURE
Cordillera Administrative Region
BPI Compound, Easter Road, Guisad, Baguio City
APPLICATION FOR LEAVE
1. OFFICE/DEPARTMENT
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
Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Mandatory/Forced Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Maternity Leave (R.A. No. 11210 IRR issued by CSC, DOLE and SSS)
Paternity Leave (R.A. No. 8187/ CSC MC No. 71, s. 1998, as amended)
Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Solo Parent Leave (R.A No. 8972/ CSC MC No. 8, s. 2004)
Study Leave (Sec. 58, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
10-Day VAWC Leave (R.A No. 9262/ CSC MC No. 15, s. 2005)
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
Special Leave Benefits for Women (R.A No. 9710/ CSC MC No. 25, s. 2010)
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended)
Adoption Leave (R.A. No. 8552)
Others:
6.B DETAILS OF LEAVE
In case of Vacation/Special Privilege Leave:
Within the Philippines
Abroad (Specify)
In case of Sick Leave:
In Hospital (Specify Illness)
Out Patient (Specify Illness)
In case of Special Leave Benefits for Women:
(Specify Illness)
In case of Study Leave:
Completion of Master's Degree
BAR/Board Examination Review
Other purpose:
Monetization of Leave Credits
Terminal Leave
6.C NUMBER OF WORKING DAYS APPLIED FOR
INCLUSIVE DATES
6.D COMMUTATION
Not Requested
Requested
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION
7.A CERTIFICATION OF LEAVE CREDITS
As of
Vacation Leave
Sick Leave
Total Earned
Less this application
Balance
NAME
Administrative Officer V (HRMO III)
7.B RECOMMENDATION
For approval
For disapproval due to
NAME
Chief, Administrative and Finance Division
7.C APPROVED FOR:
days with pay
days without pay
others (Specify)
7.D DISAPPROVED DUE TO:
NAME
Regional Executive Director