Leave Application Form - Human Resources
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.
***Related Overtime Request Form signed by supervisor should be attached.
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