LEAVE FORM
Name
*
First Name
Last Name
*
Annual Leave
Medical Leave (MC)
Emergency Leave
Compassionate Leave
Reason For Leave
From
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
To
*
-
Month
-
Day
Year
Date
Persone To Contact ( Incase Emergency )
-
Area Code
Phone Number
Number Of Days Applied
*
1/2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Application Leave Subjected To Approval.
Notified Office 5 Days In Advance.
Emergency Leave - Call Office By 9.30am
Medical Certificate [ MC ] To Be Submited The Following Days.
Compassionate Leave - To Submit Death Certificate Or Other Relevant Document Where Applicable
Applicant Signature
Approved Signature
Submit
Should be Empty: