Republic of the Philippines
Bulacan State University
City of Malolos, Bulacan
Tel/Fax (044) 791-0153
HUMAN RESOURCE MANAGEMENT OFFICE
REQUIREMENTS FOR APPLICATION FOR LEAVE
1. Compensatory Leave (Used within 1 year only)
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Approved Letter
(1 Original) Accomplishment Report (Daily)
(2 Original) CSC Form No. 48: Daily Time Record
(2 Original) Approved Certification of Compensatory Overtime Credit - HRMO
2. Maternity Leave
(2 Original) CSC Form No. 6: Application for Leave
(4 Original) CSC Form No. 7: Clearance Form
(2 Original) CSC Form No. 41: Medical Certificate
(2 Original) BulSU-OP-HRMO-05F2: Return to Service
(2 Original) CSC Form No. 211: Medical Certificate (For Employment)
(1 Original) Medical Certificate from attending Physician for Fit to Work
(1 Photocopy) Certificate of Live Birth (Son/Daughter)
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service)
3. Maternal & Paternal Leave to Adoptive Parents (Maximum of 7 days)
(2 Original) CSC Form No. 6: Application for Leave
(1 Authenticated Copy) Pre-Adoptive Authority issued by the DSWD - before the grant of the petition for adoption
(1 Authenticated Copy) Decree of Adoption issued by the proper court - after the grant of the petition for adoption.
(1 Photocopy) Certificate of Live Birth (Adopted Child)
4. Monetization
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Approved Letter
(1 Original) Supporting Documents (more than 50% Leave Credits)
5. Paternity Leave (Maximum of 7 days)
(2 Original) CSC Form No. 6: Application for Leave
(1 Photocopy) Certificate of Marriage
(1 Photocopy) Certificate of Live Birth (Son/Daughter)
6. Rehabilitation Leave (Maximum of 6 Months)
(1 Original) Approved Letter
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Medical Certificate (more than 5 days but less than 30 days)
(2 Original) CSC Form No. 41: Medical Certificate (30 calendar days or more)
(4 Original) CSC Form No. 7: Clearance Form (30 calendar days or more)
(2 Original) BulSU-OP-HRMO-05F2: Return to Service (30 calendar days or more)
(2 Original) CSC Form No. 211: Medical Certificate (For Employment) (30 calendar days or more)
(1 Original) Medical Certificate from attending Physician for Fit to Work
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service) (30 calendar days or more)
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7. Sabbatical Leave (Rest and Recreation)
(1 Original) Approved Letter
(1 Photocopy) Approved Board Resolution
(1 Original) Medical Certificate
(4 Original) CSC Form No. 7: Clearance Form
(1 Original) Notarized Contract
(2 Original) BulSU-OP-HRMO-05F2: Return to Service
(2 Original) CSC Form No. 211: Medical Certificate (For Employment)
(1 Original) Medical Certificate from attending Physician for Fit to Work
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service)
8. Sick Leave
(1 Original) Approved Letter (30 calendar days or more)
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Medical Certificate (more than 5 days but less than 30 days)
(2 Original) CSC Form No. 41: Medical Certificate or Medical Certificate from Attending Physician (30 calendar days or more)
(4 Original) CSC Form No. 7: Clearance Form (30 calendar days or more)
(2 Original) BulSU-OP-HRMO-05F2: Return to Service (30 calendar days or more)
(2 Original) CSC Form No. 211: Medical Certificate (For Employment) (30 calendar days or more)
(1 Original) Medical Certificate from attending Physician for Fit to Work
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service) (30 calendar days or more)
9. Sick Leave Benefits for Women under R.A. 9710 (Magna Carta of Women) - MINOR- maximum of 2 weeks - MAJOR- maximum of 2 months
(1 Original) Approved Letter (30 calendar days or more)
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Medical Certificate and Medical Abstract
(1 Original) Certification from BulSU Physician
(4 Original) CSC Form No. 7: Clearance Form (30 calendar days or more)
(2 Original) BulSU-OP-HRMO-05F2: Return to Service (30 calendar days or more)
(2 Original) CSC Form No. 211: Medical Certificate (For Employment)
(1 Original) Medical Certificate from attending Physician for Fit to Work
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service) (30 calendar days or more)
10. Special Emergency Leave/Calamity Leave (Maximum of 5 days)
(2 Original) CSC Form No. 6: Application for Leave
(1 Photocopy) Declaration on State of Calamity or Incident Report
Picture of Result of Calamity
11. Solo Parent Leave (Maximum of 7 days)
(2 Original) CSC Form No. 6: Application for Leave
(1 Photocopy) ID as Solo Parent
(1 Photocopy) Certificate of Live Birth (Son/Daughter)
12. Study Leave
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Approved Letter
(4 Original) CSC Form No. 7: Clearance Form
(1 Original or 1 Photocopy) Approved Study Plan
(2 Original) BulSU-OP-HRMO-05F2: Return to Service
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service)
(1 Certified Copy) Certificate of Grades/Transcript of Records
(1 Certified Copy) Diploma
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13. Ten-Day Leave under R.A. 9262
(2 Original) CSC Form No. 6: Application for Leave
(1 Original or Certified Copy) Barangay Protection Order
(1 Original or Certified Copy) Temporary/Permanent Protection Order form the court
(1 Original or Certified Copy) Certification issued by the Punong Barangay/Kagawad or Prosecutor or the Clerk of Court
(1 Original or Certified Copy) Police report specifying the details of the occurrence of violence
14. Terminal Leave
(2 Original) IPCR/OPCR
(4 Original) CSC Form No. 6: Application for Leave
(2 Original) Letter of Retirement/Resignation approved by University President
(4 Original) SALN (Date of Effectivity for Terminal Leave)
(4 Original) CSC Form No. 7: Clearance Form
(1 Photocopy) Birth Certificate
(1 Photocopy) PSA Marriage Certificate – for change of name of married
(1 Photocopy) GSIS Application for Retirement/Separation/Life Insurance Benefits or GSIS Application for Disability Retirement (RA660/ RA8291)
or GSIS Application for Retirement Under RA 7699 (Portability Law)
(1 Original or Certified True Copy) GSIS Retirement Voucher
(1 Original or Certified True Copy) GSIS Retirement Clearance
(1 Original) Updated Service Record - RECORDS OFFICE
(1 Photocopy) Latest Notice of Salary Adjustment and Notice of Step Increments (if applicable) - RECORDS OFFICE
(2 Original) Certification on Leave Without Pay (LWOP) - HRMO
(2 Original) Employee Leave Record - HRMO
(2 Original) Statement of Leave Credits Earned certified by HRMO
Additional requirements in case of death of claimant
(1 Photocopy) GSIS Application for Survivorship
(1 Photocopy) GSIS Application for Funeral Benefits
(1 Photocopy) GSIS Affidavit of Surviving Heirs/ Spouse/ Guardian of Minor or Dependent Child/red
(1 Photocopy) GSIS Memorial Plan Release and Quit Claim Form
(1 Photocopy) Death Certificate
(1 Photocopy) Marriage Contract (if Beneficiary is Spouse)
(1 Photocopy) Birth Certificates of all surviving legal heirs (if Beneficiary is Children)
Designation of next-of-kin
Waiver of rights of children 18 years old and above
Affidavit of two disinterested parties that the deceased is survived by legitimate and illegitimate children (if any), natural, adopted or children of prior marriage
REQUIREMENTS FOR GSIS
(2 Original) GSIS Application for Retirement/Separation/Life Insurance Benefits
(1 Original) Updated Service Record - RECORDS OFFICE
(1 Original) Certification of Last Day in Service - RECORDS OFFICE
(1 Original) Certification of No Pending Case - RECORDS OFFICE
(1 Piece) 1x1 Picture
REQUIREMENTS FOR LAST SALARY
(1 Photocopy) Updated Service Record
(1 Photocopy) CSC Form No. 7: Clearance Form
(2 Original) CSC Form No. 48: Daily Time Record
15. Vacation Leave
(2 Original) CSC Form No. 6: Application for Leave
(1 Original) Approved Letter (Travel Abroad and leave for 30 calendar days or more)
(4 Original) CSC Form No. 7: Clearance Form (30 calendar days or more)
(2 Original) BulSU-OP-HRMO-05F2: Return to Service (30 calendar days or more)
(2 Original) CSC Form No. 48: Daily Time Record (1 Month of Service) (30 calendar days or more)
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16. Wedding Leave (Maximum of 5 days)
(2 Original) CSC Form No. 6: Application for Leave
(1 Photocopy) Certificate of Marriage Prepared by:
JOSELYN S. SIEGA
Admin Aide III, HRMO-RSA Unit
Noted:
CARMELITA B. SANGA, RGC Director, HRMO-RSA Unit
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