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FORM6

This document is a civil service form application for leave submitted by Engel Del Rosario Buton, a teacher at Aya-aya Elementary School in Lugait, Misamis Oriental. Buton is applying for 1 day of sick leave from October 12, 2023 due to an outpatient check up for kidney stones. The form provides sections for the applicant and approving officers to provide details of the leave request, including type of leave, dates, certification of leave credits, and approval or disapproval.

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Roselle Bugay
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20 views

FORM6

This document is a civil service form application for leave submitted by Engel Del Rosario Buton, a teacher at Aya-aya Elementary School in Lugait, Misamis Oriental. Buton is applying for 1 day of sick leave from October 12, 2023 due to an outpatient check up for kidney stones. The form provides sections for the applicant and approving officers to provide details of the leave request, including type of leave, dates, certification of leave credits, and approval or disapproval.

Uploaded by

Roselle Bugay
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 6

Revised 2020 ANNEX A


Republic of the Philippines
Department of Education
SCHOOLS DIVISION OF MISAMIS ORIENTAL
Don Apolinar Velez St., Cagayan de Oro City
___________________
Date Received
APPLICATION FOR LEAVE
1. OFFICE/DEPARTMENT 2. NAME: (Last) (First) (Middle)
AYA-AYA ES/LUGAIT BUTON ENGEL DEL ROSARIO
3. DATE OF FILING: 10/12/2023 4. POSITION: TEACHER I 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.8, s.2004) In Hospital (Specify Illness)
Special Privilege Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No.292)  Out Hospital (Specify Illness)
Solo Parent Leave (R.A. No.8972 / CSC MC No.8, s.2004) Check Up (Kidney Stone)
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 (R.A. 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 (R.A. 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 APPIED FOR 6.D COMMUTATION


1 DAY CHARGED TO SERVICE CREDIT Not Requested
INCLUSIVE DATES Requested

12-Oct-23 ENGEL D. BUTON


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

BOBBY A. MORAL
School Principal

Authorized Officer

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


days with pay
days without pay
others (Specify)

ERLINDA G. DAEL, PhD, CESE


OIC, Assistant Schools Division Superintendent

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