Leave Application Form

A.      Leave Applications should be submitted through the Executive Dean/Director to
the Human Resources Division. Applications for Recreation Leave to be submitted at least
one month in advance.

1	Name:

          	    a)   Position:

          	    b)   School/Centre/Division:

2	Type of Leave: _______________________________________________________

	    Recreation/Sick/Special (Compassionate)/LWOP/Other

                 a) Dates:      From _________________ to ___________________ 

                 b) Time:       From _______________am/pm to _______________ am/pm

                 c) Reason for Leave _______________________________________________

3 Sick Leave (Medical Certificate Attached) Yes No

4 Instruction for payment of salary during leave:

a) As Usual:

b) In Advance:

5 Leave Address & Destination:

a) Leave Address: ______________________________________

_____________________________________________________

b) Destination: _________________________________________

6            Names and details of accompanying family members:

                  a) Name;                   	     Relationship;                       Age/Date of Birth

                  ___________________        _____________________      ____________

                  ___________________        _____________________      ______________

                  ___________________        _____________________      ______________

b) Travel Warrant Requested: Yes No

                    c) Name of Travel Agent:____________________________________________

7            Signature of applicant: ___________________________ Date: ________________

8            Signature of Exec Dean/Director: ___________________ Date: _______________

Recommended: Not Recommended:

9            For Staff Office Use Only

                   a) Leave Applied For: _______________________

                   b) Entitlement: _____________________________

c) Approved: Not Approved:

                   d) Staff Officer: ___________________ Date: _________________

            Card Noted __________ SVN No. _____  Control Form _____  Advice Sent _______

            Fare Entitlement ____________ Due ______________ Balance ________________

            Warrant No.  ______________  Date  ______________ Card Noted _____________