ZPS 11 FORM (1976)
Stocked by Govt Printer
(50m c807 12/81 P/F4
Distribution: Original to Officer
Permanent Secretary to Officer’s Ministry or Province
Permanent Secretary, Personnel
Senior Finance Officer (Salaries) Ministry of Finance
District Secretary or Head of Department
ZAMBIA PUBLIC SERVICE (LOCAL CONDITIONS)
APPLICATION FOR MATERNITY LEAVE AND LEAVE CERTIFICATE
The original and four copies if the form are to be completed by the applicant and forwarded to his Permanent Secretary, through the
District Secretary or Head of Department in accordance with General Order F 44.
PART 1
Surname ……………………………………. Other Names ………………………………………
Personnel Division File No……………………………… NRC……………………………………………
Ministry/province ……………………………………Ministry File No.……………………………………
Division ……………….……………………… Salary K…………………………………per annum
Period of leave applied for ………………….. days from ……………………19………………………….
Date of return to duty after last leave (or date of appointment if leave no previously taken) ………………...
Date on which leave was last commuted …………………………………………….
Date on which leave travel warrant was last received ………………………………..
I now apply to take ……………. Days ………………………. (State type of leave now applied for –
ordinary, Special, Maternity, etc see section F of General Orders) the first of which is to be
…………………………. And to commute …………………………. Days, making a total of …………….
Days. Duty to resume on ……………………………………..
Salary on leave to be paid * in the normal way/in advance in to he last day of the month proceeding my
return from leave.
My address on leave will be…………………………………………….………………………………
………………………………………………………………………………………………………….
……………………………………………………………………………………………………………
………………………………………….
Date: ……………………………………… Signature of applicant
PART II
(To be completed by Head of Department)
The foregoing application is forwarded and recommended. I certify that the details are correct.
The applicant is (1) an established officer*
(ii) serving on probation/agreement*
Signature ……………………………….
Date ……………………………. Designation …………………………….
PART III
(To be completed by the Personnel Officer’s Ministry or Province)
Date present period of qualifying service commenced …………………………………….
Odd days of qualifying service brought forward from previous application for leave and leave certificate
………………… days.
Qualifying service from date of return to duty after the last leave to date of proposed leave (see note (i) :
Subsequent qualifying service (as calculated overleaf) and leave due:
From …………………. To…..………….. in Division III ………………. months …………. days
From ………………….. to ……..………. in division II ………………... months …….……. days
From ………………….. to ……..………. in division I ………………... months …….……. days
Total (see note (ii) _______________________________________
_______________________________________
Equals …………….. completed months of qualifying service and ………….. days of qualifying earned
leave brought forward from previous application for leave and leave certificate = ………………. days
Completed ………… months in division III @ ……… days per month = ………………… days
Completed ………… months in division II @ ……… days per month = ………………… days
Completed ………… months in division I @ ……… days per month = ………………… days
Deduct leave taken if any (including advanced leave and periods of leave of
Less than 30 days granted since (a) above) ………….. Days
_____________
Total leave now available _____________
Leave t o be carried forward ……………… days
The officer is/is not entitled to leave travel warrants for himself/herself.
He/she may be granted ……………………………………. Days additional leave.
Date ……………………………………. Signature …………………………………..
Designation …………………………………
PART IV
(To be completed by Ministry Headquarters)
I Hereby certify that Mr/Mrs/Mrs ……………………………………………………………..
Is now granted ………………….. days leave with pay
………………….. Days leave with half pay
.…………………. Days leave without pay
A total of ------------------------- days leave * plus ------------------------- days additional leave
Commencing on ……………………………………. 20……
Is due to resume duty on ………………………………………………… 20 ………
……………………………………… …………………………………….
Date Permanent secretary
Delete where inapplicable Ministry of ……………………………...
