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VEERAPPA NISTY ENGINEERING COLLEGE

Hasanapur,Tq:- Shorapur-585224 Dist:- Yadgir
E-mail:veerappanisty@hotmail.com

LEAVE APPLICATION FORM

______________________________________________________________________________
1. Name of the staff :_____________________________________________
2. Designation :_____________________________________________
3. Department / Section :_____________________________________________
4. Nature of Leave Applied : C.L / V.L / M.L / D.L /E.O.L /LWP_______
5. Period of Leave : From____________ to ___________No of days______
6. Casual Leave at Credit :_____________________________________________
7. Reason for Leave :_____________________________________________
______________________________________________
______________________________________________
8. Work Load Arrangement :
Sl. Class/ Alternate
Date Day Period Time Subject/Lab Signature
no Sem. Staff Name
1
2
3
4
5
6
7
8

Arrangement of the important responsibility if any:

Signature of Dealing Clerk Date: Signature of Applicant

______________________________________________________________________________
Recommendation of HOD/Section Head

Recommended/Forwarded/Not recommended for the fallowing reason:

Sanctioned/Rejected

Signature of HOD/Section Head Principal Signature