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LEAVE APPLICATION FORM

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:____________________________________________________

____________________________________________________

*RECOMMENDED / NOT RECOMMENDED APPROVED / NOT APPROVED

_____________________ __________________ _________________________ ___________________


Head of Department Date CEO Date