Republic of the Philippines
Supreme Court of the Philippines
Taft Ave. Cor. Padre Faura St.
Ermita, Manila
APPLICATION FOR LEAVE
1. OFFICE/DEPARTMENT 2. NAME: (Last) ARCILLA (First) MENILYN (Middle) BORJA
3. DATE OF FILING DEC. 10, 2021 4. POSITION INTERPRETER III 5. SALARY _________________
6. DETAILS OF APPLICATION
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 ______________________________
X 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. 292) X Out Patient (Specify Illness) COUGH & COLD
Solo Parent Leave (RA No. 8972/CSC MC No. 8, s. 2004) In case of Special Leave Benefits for Woment:
Study Leave (Sec. 68, Rule XVI Omnibus Rules Implementing E.O. No. 292 (Specify illness) ____________________________________
10-Day VAWC Leave (R.A. No. 9262 / CSC MC No. 15, s. 2005) In case of Study Leave:
Rehabilitation Privilege (Sec. 55 Rule XVI, Omnibus Rules Implementing E.O. No. 292 Completion of Master's Degree
Special Leave Benefits for Women (RA No. 9710/CSC MC No. 25, s 2010) BAR/Board Examination Review Other
Special Emergency (Calamity) Leave (CSC MC No. 2, s 2012, as amended) purpose: ______________________________________
Adoption Leave (RA No. 8552) Monetization of Leave Credits
Others: _________________________________ Terminal Leave
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION
5 DAYS Not Requested
______________________________________________________________________ X Requested
INCLUSIVE DATES
DEC. 1 TO 3 , 7 & 9, 2021 _____________________________________________________
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION
7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of ______________________________________________ For approval
For disapproval due to ___________________________________
______________________________________________________
______________________________________________________
__________________________________________________________ ____________________________________________________
Authorized Officer Authorized Officer
_______________________________________________________________________________________________________________________________________
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO: _____________________________
_________ days with pay ______________________________________________________
_________ days without pay ______________________________________________________
_________ others (Specify) ______________________________________________________
_____________________________________________________
Authorized Officer
Republic of the Philippines
Supreme Court of the Philippines
Taft Ave. Cor. Padre Faura St.
Ermita, Manila
APPLICATION FOR LEAVE
1. OFFICE/DEPARTMENT 2. NAME: (Last) (First) (Middle)
3. DATE OF FILING ________________________ 4. POSITION ________________________________________ 5. SALARY _________________
6. DETAILS OF APPLICATION
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. 292) Out Patient (Specify Illness) _____________________________
Solo Parent Leave (RA No. 8972/CSC MC No. 8, s. 2004) In case of Special Leave Benefits for Woment:
Study Leave (Sec. 68, Rule XVI Omnibus Rules Implementing E.O. No. 292 (Specify illness) ____________________________________
10-Day VAWC Leave (R.A. No. 9262 / CSC MC No. 15, s. 2005) In case of Study Leave:
Rehabilitation Privilege (Sec. 55 Rule XVI, Omnibus Rules Implementing E.O. No. 292 Completion of Master's Degree
Special Leave Benefits for Women (RA No. 9710/CSC MC No. 25, s 2010) BAR/Board Examination Review Other
Special Emergency (Calamity) Leave (CSC MC No. 2, s 2012, as amended) purpose: ______________________________________
Adoption Leave (RA No. 8552) Monetization of Leave Credits
Others: _________________________________ Terminal Leave
6.C NUMBER OF WORKING DAYS APPLIED FOR 6.D COMMUTATION
Not Requested
______________________________________________________________________ Requested
INCLUSIVE DATES
______________________________________________________________________ _____________________________________________________
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION
7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of ______________________________________________ For approval
For disapproval due to ___________________________________
______________________________________________________
______________________________________________________
__________________________________________________________ ____________________________________________________
Authorized Officer Authorized Officer
_______________________________________________________________________________________________________________________________________
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO: _____________________________
_________ days with pay ______________________________________________________
_________ days without pay ______________________________________________________
_________ others (Specify) ______________________________________________________
_____________________________________________________
Authorized Officer
