LEAVE APPLICATION FORM
SURNAME: ……………………………………FIRST NAME: …………………………………………….
DESIGNATION: ………………………………………MAN NO.………………………………………………
DEPARTMENT: ……………………………………………………………………………………...………
ADDRESS WHILST ON LEAVE: ……...…………………………………………………………………...
PHONE NUMBER:……………………………………………………………………………………………
TICK WHERE APPLICABLE:
1. ANNUAL LEAVE …………. 2. MATERNITY LEAVE …………….
3. SICK LEAVE ………….. 4. STUDY LEAVE ……………..
5. UNPAID LEAVE ………….. 6. COMPASSIONATE LEAVE ……............
7. MOTHERS DAY …………... 8. PATERNITY LEAVE …………….
9. FAMILY RESPONSIBILITY ………………
APPLICATION FOR: ………………DAY(S) LEAVE.
I hereby apply for ………… day(s) leave as from ….……...….……..Upto ……………………………
(Inclusive) ……..….…..…… (Inclusive), reporting back on ……………………………………………
Intervening Public Holiday(s): …..…………….………………………....…………...…….… day(s).
The reason(s) for leave is / are: …..…………………………………………..………………………….…….
…………………………………...…………………………………………………………………………….
DATE: ………………………..…… SIGNATURE OF THE APPLICANT: …...……….…………………...
Recommended / Not Recommended (Supervisor) Name: ………………………… Sign: …………………...
Approved / Not Approved (Manager)….……..………………………………………...Date………......................
OFFICIAL USE ONLY-HR
Applicant has ………accrued leave days to his/her credit: HRM…………………Date………......................
NOTES:- 1) Leave application form must be submitted 2 days prior to commencement of leave.
2) Management may or may not approve the leave application
3) An Employee can only proceed on leave upon express approval of this leave application.