Civil Service Form No.

6
Revised 2020
ANNEX A
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS ____________________
CORDILLERA ADMINISTRATIVE REGION Date of Receipt

Engineer's Hill, Baguio City

APPLICATION FOR LEAVE

1. Office / Division 2. Name (Last) (First) (Middle)
Administrative

3. Date of Filing 4. Position 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. 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 (R.A. No. 8972 / CSC MC No. 8, s 2004)

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. 8552) BAR/Board Exam Review

Other Purpose:

Others Monitization of Leave Credits

Terminal Leave

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

Not Requested
INCLUSIVE DATES: Requested

Signature of Applicant

7. DETAILS OF ACTION OF APPLICATION

7. A CERTIFICATION OF LEAVE CREDITS: 7.B RECOMMENDATION:
AS OF For Approval

VACATION SICK For Disapproval due to

Total Earned
Less this application
Balance

STELLA S. MIRANDA JOSEPHINE B. LAGASCA

Administrative Officer V Chief, Administrative Division
Chief, Human Resource Management Section

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

Day(s) with pay Approved
Day(s) without pay
Others (Specify) Disapproved due to
REYNALDO C. ALCONCEL
Assistant Regional Director
 DPWH-HRAS-HRMD Form No. 07, s. 2021
Civil Service Form No. 6 Revised
Revised 2020
ANNEX A
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
CORDILLERA ADMINISTRATIVE REGION ____________________
Engineer's Hill, Baguio City Date of Receipt

APPLICATION FOR LEAVE

1. Office / Division 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: 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 (R.A. No. 8972 / CSC MC No. 8, s 2004)

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. 8552) BAR/Board Exam Review

Other Purpose:

Others Monetization of Leave Credits

Terminal Leave

Signature of Applicant
6.C NUMBER OF WORKING DAYS APPLIED FOR: 6.D COMMUTATION:
Not Requested
INCLUSIVE DATES: Requested

Signature of Applicant
7. DETAILS OF ACTION OF APPLICATION
7. A CERTIFICATION OF LEAVE CREDITS: 7.B RECOMMENDATION:
AS OF For Approval
VACATION SICK For Disapproval due to
Total Earned
Less this application
Balance

STELLA S. MIRANDA
Administrative Officer V
Chief, Human Resource Management Section
7.C APPROVED FOR: 7.D DISAPPROVED DUE TO:
Day(s) with pay
Day(s) without pay
Others (Specify)
Approved by:
REYNALDO C. ALCONCEL
Assistant Regional Director