Name : ______________________________ Position:__________________________
Department :_______________________________ Staff No:__________________________
I wish to apply for (Please ( / ) accordingly )
Annual Leave Unpaid Leave Medical Leave
Maternity Leave Compassionate Leave Training Leave
Replacement Leave for: _________________________ (Date) Name of Event:_________________________
From / On ________________________________ to __________________________ (___________ Day(s))
Date recommence duty: _________________ Contact details during leave: __________________ Reason (s): ___________________________________________________________________________________ During my absence, duties will be taken over by : ________________________________________
Applicant signature: ____________________________ Date : _____________________________
FOR HUMAN RESOURCE / ADMISTRATION DEPARTMENT USE ONLY
A. Leave Entitlement ________ :____________
B. C/ Forward ________ :____________ CERTIFIED BY: C. Total :____________ D. Earned annual leave as at :____________ E. Taken (Incl. This application) :____________ ____________________________ F. Unpaid leave :____________ G. Balance Leave :____________
TO BE COMPLETED BY CEO/ HEAD OF DEPARTMENT
Comments by Head of Department:____________________________________________________