Kevian KKL-HR-FM 10(2) Issue Date:27/07/2017 Approved for use by
Kenya Ltd revision date: 4/11/2022 MR/FSDTL
Re-issue date: 16/11/2022 Issue A
LEAVE APPLICATION FORM
PART I
TO BE
COMPLETED Name……………………………………………………………… S/No.…………………….
BY
EMPLOYEE Designation: …………………………………………. Grade: ……………………………….
Department: ………………………………………….. Section: ……………………………….
Date of employment:/joining: …………………… Last date taken leave: ………………
Nature of leave requested……… (tick) (Annual, Unpaid, sick, Maternity, Paternity,
Emergency, Compensatory, or any other) ………………………………………………………
No of Days applied for: ………………………… Date of compensation: ………....…………
Address while on leave: ……………………………… Telephone number: ………………………
From: ……………… To: ……………….. Signature: …………………… Date:
………………
PART II
TO BE
COMPLETED Leave b/f: ……..………….days Leave earned during current year: ……………….…..days
BY
HUMAN Total leave: ………………days Leave Taken this year…………………..days
RESOURCE
DEPARTMEN
T
Less this leave application: …………………...days
Balance of leave c/f…………days Date due to resume duties: ……...………….……
Prepared by…………………………….. (HRO/HRA) Date ………..…… Sign………………
Checked by……………… HR & ADMIN MANAGER Date …………... Sign…………….
PARTIII
TO BE (i) Alternative arrangements can be made and no replacement is required
COMPLETED
BY HOD (ii) Not recommended – Reason: ……………………………………………….…………………
Signature: ……………………………………… Date……………………………………………
PARTIV
TO BE Leave approved/ Not approved ( tick)
APPROVED Reason ………………………………………………………………………………………………
BY MD/ED
Signature……………………………….… Date: ……………… Designation: …………………
General Information
1. Annual leave considered upon completion of 12 months. However in the event of an emergency leave may be
considered and debited on annual leave account, pending earning of leave. Alternatively, application will be
considered as unpaid leave.
2. Application for annual leave must be submitted at least 14days in advance of commencement of the proposed
leave except in a case of an emergency
3. If after approval any amendments is made or required, a fresh application must be submitted clearly cancelling
the previous leave application
4. Compensatory leave will be considered against overtime worked or working on rest / Public holiday(s)
5. Sick leave, Maternity & Paternity are granted upon submission of supporting documents.
KEY: MD- Managing Director, ED-Executive Director, HOD- Head of Department, b/f- brought
forward, c/f - carried forward, s/no – payroll number
