Leave Request Form

UN Volunteer’s name:
Host Agency:
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 of the host agency

Signature: __________________________ Date: __________

Name: __________________________
Org. unit: __________________________

Please note:
* Requires supervisor's approval.
** Supervisor’s approval not necessary, however s/m must inform supervisor and leave monitor when on sick
leave. For “certified” sick leave, medical certification should be submitted to Leave Monitor upon return and
certified sick leave of more than 10 working days must be approved by UN Medical Director in New York.
*** Related Overtime Request Form signed by supervisor should be attached.
**** UN Volunteers are entitled with up to 10 days for training and learning leaves per 12 month contract.

Please forward the signed form to your Leave Monitoring focal point.