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Leave Form

The document is a leave application form for employees of the National Health Mission (NHM) to request various types of leave, including casual, earned, maternity, or loss of pay. It requires personal details such as name, designation, and leave period, along with reasons for the leave. The form must be completed accurately, as incomplete applications will be rejected.

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proktr24
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120 views1 page

Leave Form

The document is a leave application form for employees of the National Health Mission (NHM) to request various types of leave, including casual, earned, maternity, or loss of pay. It requires personal details such as name, designation, and leave period, along with reasons for the leave. The form must be completed accurately, as incomplete applications will be rejected.

Uploaded by

proktr24
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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N ATIO NA L ii E A LT f, iv'11 S SIO N (A R O G VA 5= A A L A lV)


1 EAVF APPI ICATION FORII (CASUAL LEAVE/ EARNED L EAVE /LOP /MATERNITY LEAVE)
(To be filled by applicant)

District

1. Name of Applicant (in BLOCK Letters) Shri/Smt/Dr

2. lniLialdate of Joining in NRHM/NHM ______t_-__.


------ / - - - - - It ------

3. Designaticn

4, Name of lnstitution

5. Distri.t

6, Contract 7. Total Completed v€ars in


[:rcm Tc
Period NRHM/NHM
-----l-----/------ ----/-----l------
8. Leave Availed
dui'ing the year Casual Leave Earned Leave

9. Address for Communication


with Contact Number

Email Mobile

'l
0. Nature of Leave Required Now Casual Leave / Loss of Pay i Maternity Leave / Earned Leave

From To

i. Leave Period
1
------/----/-----------/-----/------
'l
2. Reason fcr Leave

13. Sunciays & Hclidays if any, propcsed


to be prefixed/suffixeci to leave Prefrx

5uffix

Dare: ---- -/-----/-- --- Signature of Applicant

OTFICE I"JSE ONLY

Remarks fror-n the lnstitution \(/crking Renrarks frcm District Programrne llanager

.the
Nai-ne & Signature of the Officer with O"f ce seal Signatuie cf Cficer rviih Office sea!

Note: 1. Al! the fields are tu1anCa1.ory.


2. Those leave appiication incomplete in any respect wiil be rejecteC'
3. Aay leave acplication aiher than tne above folnrai wili not be consicjereci
,i. Appllcants shali proceed for re:ve only arter the a:provalf i-on: competeilt authority

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