Application for Children Care Leave (CCL)
1 Name of Applicant
2 Designation
3 Husband's Name
4 Date of Appointment
Age of Child/Children of
5
Applicant
6 Residential Address
7 Name of School
8 Name of Zone
9 No. of Days CCL Applied for
No. of Days CCL Already Availed
10
by Incumbent
Strength of Teacher in the School:-
11 1.) Male
2.) Female
12 No. of Students in the School
13 No. of Section in the School
No. of Teachers on CCL/Long
14
Leave in the School
Does Grant of CCL to the
15 Incumbent may Affect the Study
of Students?
Remarks With Signature
Principal
School Inspector
ADE/DDE