Fillable Printable Child Care Leave Form Template
Fillable Printable Child Care Leave Form Template
Child Care Leave Form Template
APPLICATION FOR CHILD CARE LEAVE
1. Name of the Applicant : _______________________
2. Designation : _______________________
3. Dept/Office/Section : _______________________
4. Name of Child for whom Child
Care leave is applied for : ________________________
5. Date of Birth of the Child : ________________________
6. Date on which child will be attaining
18 years. : _________________________
7. Is the child among the two eldest
Children : Yes/No
8. EL in credit (as on date) : _________________________
9. Period of Leave- Days : From_________To_______
Prefix/Suffix of holidays, if any : _______________________
10. Reason(s) for leave applied for : _______________________
11. Total Child Care Leave availed till date : ________________________
12. (a) Whether permission to leave : Yes/No
station is required
(b) If Yes, Address during : ________________________
leave period ________________________
________________________
13. Date of return from last leave, : ________________________
& nature and period of that leave ________________________
Date : _____________ Signature of applicant
Pay Card No._______
Remarks of Controlling Officer
Leave Recommended / Leave Not Recommended.
Date :______________ Signature______________
Designation____________
Office_________________
