LEAVE APPLICATION FORM

Document No. Title : : Human Resources Manual Forms Valid Date : 01/08/19 Page No:
CC001RE 1 of 7
Doc Type : Prepared By: P Sibanda Approved By. C Dimba Rev. No: 0
Record
Signed Signed:

1. NAME OF APPLICANT : ...........................................……..EMPLOYEE NO: ...................

2. DEPARTMENT : ............................................…………….STATION: ...........................

3. NATURE OF LEAVE: Vacation/Special/Other (Delete inapplicable)

If other specify ..............................……………………………………………………………………...........…...........................

4. NUMBER OF DAYS …………………….. From ………..…………………….. To ……………………………

5. ADDRESS AND TELEPHONE NO WHILST ON LEAVE ………………………………………………….

…………………………………………………
……………………………..…………………
6. IS SURRENDER OF VACATION LEAVE FOR CASH REQUIRED? YES/NO
IF YES – NUMBER OF DAYS: ………………….……………………………………………………………………

7. IS PAY REQUIRED IN ADVANCE: YES/NO

IF YES – UP TO WHAT DATE?……………………..……………………………………………………….……….

8. DATE PAYMENT OF CILL/SALARY IN ADVANCE REQUIRED………….………………………………

9. SIGNATURE OF APPLICANT ……………………………………. DATE ……………………………

10. LEAVE RECOMMENDED ……………………………………………………………………………………………..

ACTING APPOINTMENT – YES/NO

NAME ……………………….…….. WORK NO ……….…. POST ………………………………….

DATE FROM …………………………………….. TO …………….………………………………………..

LEAVE APPROVED ………………..……… DATE …………………….……………………………………

ACTING APPOINTMENT APPROVED ………………………… DATE ……………………….…………….

(TO BE APPROVED BY BMs & HODS)
NOTES
1. Where an advancement of monies is required, applications should be submitted SIX WEEK prior to commencement of
leave.
2. Applications for URGENT PRIVATE AFFAIRS LEAVE, SPECIAL LEAVE OR STUDY LEAVE to be accompanied by a letter
stating the reasons for the application.
3. Where days surrendered for cash are more than days being taken (4 above) this application must be accompanied by
a letter stating reasons for such request.
4. ORIGINAL OF ALL APPLICATIONS FOR LEAVE TO BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT FOR
RECORD UPDATING AND ACKNOWLEDGEMENT.

TO: MR/MRS/MISS ..................................................................... DATE ..............................

This is to advise that your application for ................................... leave of ............................ days

from ....................... to ........................... inclusive HAS/HAS NOT BEEN APPROVED

HUMAN RESOURCES DEPARTMENT