Civil Service Form 6

Revised 2010

Republic of the Philippines

Department of Education
REGION III-CENTRAL LUZON
SCHOOLS DIVISION OF ZAMBALES
Zone VI, Iba, Zambales

APPLICATION FOR LEAVE

1.OFFICE/DEPARTMENT 2.NAME: (LAST NAME) FIRST NAME MIDDLE NAME
DepEd- San Fernando Elementary School MILLANES ZALDY BERNAL
3.DATE OF FILING June 25, 2025 4.POSITION HT III 5.SALARY 00.00
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)
☐Mandatory/Forced Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Vacation/Special Privilege Leave:
☐Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) ☐Within the Philippines _______________________
☐Maternity Leave (R.A. No. 11210 / IRR issued by CSC, DOLE and SSS) ☐Abroad (Specify) _______________________________
☐Paternity Leave (R.A. No. 8187 / CSC MC No. 71, s. 1998, as amended)
In case of Sick Leave:
☐Special Privilege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
☐Solo Parent Leave (RA No. 8972 / CSC MC No. 8, s. 2004) ☐In Hospital (Specify Illness) _______________________
☐Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) ☐Outpatient (Specify Illness) Dysmenorrhea
☐10-Day VAWC Leave (RA No. 9262 / CSC MC No. 15, s. 2005)
☐Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Special Leave Benefits for Women:
☐Special Leave Benefits for Women (RA No. 9710 / CSC MC No. 25, s. 2010) (Specify Illness) ____________________________________
☐Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) In case of Study Leave:
☐Adoption Leave (R.A. No. 8552) ☐Completion of master’s degree
☐BAR/Board Examination Review
Others:
Other purpose:
_______________________________________ ☐Monetization of Leave Credits
☐Terminal Leave
6.C NUMBER OF WORKING DAYS APPLIED: 1 day 6.D COMMUTATION
INCLUSIVE DATES ☐Not Requested
☐Requested
________June 24,
2025___________________________ ____________________________________
(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 ALBERTO M. OTCHENGCO JR.
Senior Education Program Specialist
OIC-Office of the Asst. Schools Division Superintendent

MARIA KRISTINA D. QUIAÑO

Admin. Officer IV / HRMO II
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:
_______ days with pay ____________________________________________________
_______ days without pay ____________________________________________________
_______ others (Specify) ____________________________________________________
___

WILLIAM RODERICK R. FALLORIN CESO VI

Assistant Schools Division Superintendent
OIC – Office of the Schools Division Superintendent