Karta Urlopowa

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.....................................

pieczątka jednostki organizacyjnej

WNIOSEK O UDZIELENIE URLOPU

Imię i nazwisko .................................
Stanowisko .........................................
Rodzaj urlopu (1) .................................
od dnia .......................... do dnia ................................................
Miejsce wykonywania obowiązków służbowych (2) nie dotyczy

............................................
Podpis i pieczątka wnioskującego

ZASTĘPSTWO NA CZAS URLOPU:

Imię i nazwisko ..................................................................................

Miejsce wykonywania obowiązków służbowych (2)

............................................
Podpis i pieczątka zastępującego

.....................................................................
....................................................................... Akceptacja, pieczątka i podpis
Ordynatora Oddziału lub Kierownika Zakładu
Akceptacja Działu Kadr i Rachuby

1) rodzaj urlopu: wypoczynkowy, bezpłatny , szkoleniowy

2) oddział, oddział dzienny, poradnia, pracownia, zakład

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