Particulars of application for leave of absence

Ministry of Education

1. Name of Applicant: _______________________________

(Give Christian names)

2. Appointment(present position) _______________________________

3. Department/Satation: _______________________________

4. Salary $: $________________

5. Date of first appointment (i.e. date on which full salary in Public Service began): ____________

Period of Service: _____ Yrs. _____ Mths.

6. Period of service in this Ministry: _____________

7. Department leave granted since 1ST January, giving dates: __________________

(vacation leave to be distinguished From half pay and Maternity leave)

8. Date of expiry of last leave: _____________

9. Leave balance to date: ___________

10. Leave now applied for : Number of days: ___________

From: __________________________________

OTHER LEAVE

Number of days________________________________________

From__________________________________________________
(Both inclusive)

On full pay _____ On half pay___ Leave without pay_____ Maternity leave______

11. Where leave is to be spent: _____________

12. Contact number/ address : ______________

13. What arrangements have been made

For performance of duties during absence : ____________________________

Signature of Applicant_______________________ Date __ ____________ ______

Recommended/ Note Recommended Immediate Supervisor___________ Date_________

Recommended/ Note Recommended Head of Department_____________ Date_________

Approved/ Not Approved Chief Executive Officer__________ Date_________