Teaching staff APPLICATION FOR _________________ LEAVE Name of the applicant Department: COMP/MECH/CIVIL/E&T.C.

Leave applied for ____________days from / Designation: ____________________ /2013 TO / /2013

Reason for Leave_______________________________________________________________ Contact address (during leave period): _______________________________________________ Mobile No._____________________________ Date: / /2013 Work Load Arrangement Day & Date Period / Class Subject Name & Substitute Signature of Substitute

(Please write overleaf if not sufficient)

Recommendation of Dean-Engg. For office use: Leave Availed Balance Applied for CL ML EL

Sign of In-charge/Coordinator

Sign of applicant

SPL

CO

Signature of A.O.

Leave Sanctioned

Not Sanctioned

Date:

/ 2013

Director I. C.