Leave Application Form - Free Download
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Leave Application Form
Staff member’s name:
Index Number:
inclusive
From
To
No. of
working days
Annual leave*
Sick Leave (certified) **
Sick Leave (uncertified) **
Compensatory Time Off***
Other types of leave* (please specify)
(i.e. .Family leave, ML, PL, Adoption leave, jury leave, HL, etc.)
My accrued leave balance as of end
is
days.
Signature: ________________ Date:
Approval by immediate supervisor
Signature: ________________ Date:
!!!!!
Name:
Org. Unit
Please note:
* Requires supervisor's approval.
**Supervisor’s approval not necessary, however s/m must inform supervisor and leave monitor
when on sick leave. For “certified” sick leave, medical certification should be submitted to Leave
Monitor upon return.
