Leave of Absence Request
Please fill out the form below and make sure you upload any relevant documentation. Before you submit this form, you must ensure that your Head of Department/ line manager has agreed the date with you.If the absence request is of a confidential nature, please see JH in person before submitting this form.
Name
*
First Name
Last Name
Please confirm you have informed your Head of department/line manager? (If you say 'no' to this, the form will close.)
*
Yes
No
Details of Leave
Leave Start
*
-
Day
-
Month
Year
Date Picker Icon
Leave End
*
-
Day
-
Month
Year
Date Picker Icon
Outline all the periods of cover your will require, including registration.
*
Reason for Absence
*
Please upload any supporting documentation
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Submit Leave of Absence Request
For Office Use Only
For Office Use Only
To be filled out after submission of Leave of Absence request.
Has the leave request been granted?
Yes
No
Is the leave of absence with or without pay
With pay
Without pay
Any additional comments
SLT Initials
*
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