Civil Service Form No.

6 ANNEX A
Revised 2020

Republic of the Philippines

Department of Education
SCHOOLS DIVISION OF SORSOGON
Sorsogon Sports Complex, Balogo Sorsogon City

APPLICATION FOR LEAVE

1. OFFICE/STATION 2. NAME: BARCELON BLEZEL ALMARIO

3. DATE OF FILING AUGUST 23, 2022 4. POSITION TEACHER III 5. SALARY29, 798

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) In case of Special Leave Benefits for Women:
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) (Specify Illness)
10-Day VAWC Leave (RA 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
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Other purpose:
Adoption Leave (R.A. No. 8552) Monetization of Leave Credits
Others: Terminal Leave

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

105 DAYS Not Requested
INCLUSIVE DATES Requested

(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION

As of

Vacation Leave Sick Leave For approval

Total Earned For disapproval due to
Less this application
Balance

GIDEON KARL L. GREFALDA Authorized Officer

Administrative Officer IV (School Head / Head of Office)

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

days with pay
days without pay
others (Specify)

JOMAR E. ENGUERRA
ADMINISTRATIVE OFFICER V
Civil Service Form No. 6 ANNEX A
Revised 2020

Republic of the Philippines

Department of Education
SCHOOLS DIVISION OF SORSOGON
Sorsogon Sports Complex, Balogo Sorsogon City

APPLICATION FOR LEAVE

1. OFFICE/STATION 2. NAME: BARCELON BLEZEL ALMARIO

3. DATE OF FILING AUGUST 23, 2022 4. POSITION TEACHER III 5. SALARY29, 798.00

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) 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) In case of Special Leave Benefits for Women:
Study Leave (Sec. 68, Rule XVI, Omnibus Rules Implementing E.O. No. 292) (Specify Illness)
10-Day VAWC Leave (RA 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
Special Emergency (Calamity) Leave (CSC MC No. 2, s. 2012, as amended) Other purpose:
Adoption Leave (R.A. No. 8552) Monetization of Leave Credits
Others: Terminal Leave

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

105 DAYS Not Requested
INCLUSIVE DATES Requested
AUG.23-DEC .05, 2022
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION

As of

Vacation Leave Sick Leave / For approval

Total Earned For disapproval due to
Less this application
Balance

GIDEON KARL L. GREFALDA Authorized Officer

Administrative Officer IV (School Head / Head of Office)

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

days with pay
days without pay
others (Specify)

JOSE L. DONCILLO
SCHOOLS DIVISION SUPERINTENDENT