Leave Request Form

Dates inclusive
No. of working
From To
days
Annual leave*                  

Sick Leave (certified) **                  

Sick Leave (uncertified) **                  

Special Leave Without Pay*                  

Compensatory Time Off***                  

Training and Learning Leave****                  

Other types of leave* (please specify)                  

(i.e. Family leave, ML, PL, Adoption leave, jury leave, HL, etc.)

I have accrued ___ days annual leave at the end of _____________ . Indicate last completed month.

In My Absence, my work will be covered by ____________________________________.

Date:
Signature of
Staff Member:

Approval by immediate supervisor

Signature: __________________________ Date: __________

Name: __________________________
Org. unit: __________________________