ࡱ> g ^bjbjVV 8r<r< *****>>>8v2>#J& FFF^Dd#######$%'p&#Q*&#**F^4w#D"D"D"j*F*^#D"#D"D"D"FvAhFD""#0#D")()(D")(*D"D"&#&#v#)( :  APPLICATION FOR LEAVE OF ABSENCE (Academic Staff) Name FORMTEXT      Department FORMTEXT      School FORMTEXT      Email Address FORMTEXT      Employment Start Date FORMTEXT      Leave Dates (exact dates  dd/mm/yy)From:  FORMTEXT       To:  FORMTEXT      Type of Leave  FORMCHECKBOX  Paid  FORMCHECKBOX  Unpaid  1. What is the purpose of the leave request?  FORMTEXT       2. The following changes to my timetable of teaching or tutorial duties would be necessary Timetable: FORMTEXT       School duties: FORMTEXT       Supervision of Research Students/Group: FORMTEXT        3. Please complete the section below if the proposed leave of absence is greater than one week List all previous periods of leave of absence in the last 3 years: FORMTEXT        What publications resulted from your last period of leave? FORMTEXT        Only in cases of unpaid leave: I understand that the employer will bear the employer pension costs of unpaid leave only after I have been employed for a minimum of five years, and only if I continue my pension contributions during my period of unpaid leave. I also understand that the college will not pay towards pension costs for any further periods of unpaid leave for another seven years after the date of return from the last period. I understand that if I take unpaid leave within first five years of employment or another period within seven years from the last I shall be required to pay the employee and employer pension costs in order to maintain pensionable service. I also understand that if I elect to continue pension contributions I must pay these on a monthly basis or as a lump sum prior to the start of my period of unpaid leave.I elect to continue pension contributions during period of unpaid leave FORMCHECKBOX  Yes  FORMCHECKBOX  NoI will pay the contributions on a monthly basis and understand these payments must be received prior to the 27th of each month FORMCHECKBOX  Yes  FORMCHECKBOX  NoI will re-pay the amount as a single lump sum prior to my period of unpaid leave FORMCHECKBOX  Yes  FORMCHECKBOX  NoSignature of Applicant:  FORMTEXT FJ^jlnxzɱq`O=)&jhi5OJQJU^JnH tH #hGOh7V5OJQJ^JnH tH  ht5OJQJ\^JnH tH  h5OJQJ\^JnH tH &hthK5OJQJ\^JnH tH &hthtT5OJQJ\^JnH tH .hGOhtT5CJOJQJ\^JaJnH tH .hGOh5CJOJQJ\^JaJnH tH  hGO5OJQJ\^JnH tH (hGOhoCJOJQJ^JaJnH tH  jhGOhGO5OJQJU JlnxR}kdr$$Ifl0J !  t0x!644 laytkQdhx$7$8$H$IfgdJ $7$8$H$a$gd$f7$8$H$]fa$gdi z    ŮŜybŮŜyKŮ,j@thi5OJQJU^JnH tH ,jDshi5OJQJU^JnH tH #hGOh7V5OJQJ^JnH tH  hGOh7VOJQJ^JnH tH #hGOhGO5OJQJ^JnH tH -jhi5OJQJU^JmHnHtH u&jhi5OJQJU^JnH tH ,jHrhi5OJQJU^JnH tH hi5OJQJ^JnH tH  n}kds$$Ifl0J !  t0x!644 laytkQdhx$7$8$H$IfgdJ   6 8 L N P Z \ ^ ` ʶygSD-S,j8vhnr5OJQJU^JnH tH hnr5OJQJ^JnH tH &jhnr5OJQJU^JnH tH #hGOhGO5OJQJ^JnH tH -jhi5OJQJU^JmHnHtH u,jErs̵̠{jjjVjVjjjB&jhJ5OJQJU^JnH tH &h{Kvh{Kv5OJQJ\^JnH tH  h&5OJQJ\^JnH tH  hu5OJQJ\^JnH tH &h{Kvhy;5OJQJ\^JnH tH )huhy;56OJQJ\^JnH tH ,huhy;56>*OJQJ\^JnH tH #hy;56OJQJ\^JnH tH  hy;5OJQJ\^JnH tH  h5OJQJ\^JnH tH )*r~p $7$8$H$Ifgdnrxx$7$8$H$Ifgdunkd$$Ifl J! t0644 lap yt{Kvs ./0>?@WXftcO8,jhJ5OJQJU^JnH tH &h{KvhE5OJQJ\^JnH tH  hJ5OJQJ\^JnH tH )hEhE5H*OJQJ\^JnH tH  hE5OJQJ\^JnH tH &h{Kvhy;5OJQJ\^JnH tH ,jрhJ5OJQJU^JnH tH &jhJ5OJQJU^JnH tH ,j]hJ5OJQJU^JnH tH hJ5OJQJ^JnH tH /lxfX $7$8$H$Ifgdnrxx$7$8$H$IfgdnrkdE$$Ifl0 ] t0644 lapytnrfghklmƲybKƲ9#h{Kvhy;5OJQJ^JnH tH ,jhJ5OJQJU^JnH tH ,jmhJ5OJQJU^JnH tH &h{KvhE5OJQJ\^JnH tH  hE5OJQJ\^JnH tH &h{Kvho@5OJQJ\^JnH tH &h{KvhJ5OJQJ\^JnH tH hJ5OJQJ^JnH tH &jhJ5OJQJU^JnH tH ,jYhJ5OJQJU^JnH tH lmxfX $7$8$H$Ifgdnrxx$7$8$H$Ifgdukd͂$$Ifl0 ] t0644 lapytnrVVxhZ $7$8$H$Ifgd{Kvx$7$8$H$IfgdnrkdU$$Ifl0 ] t0644 lapytnr !V V VVVVVDVFVHVJVzVVXìܚududPH<3<h l5OJQJhGOhYy.5OJQJhGOOJQJ&hGOhy;5OJQJ\^JnH tH  h5OJQJ\^JnH tH  hy;5OJQJ\^JnH tH &h{Kvhy;5OJQJ\^JnH tH #h{Kvhy;5OJQJ^JnH tH -jhnr5OJQJU^JmHnHtH uU,jhnr5OJQJU^JnH tH &jhnr5OJQJU^JnH tH hnr5OJQJ^JnH tH        APPLICANT CONFIRMATION I understand that Leave of Absence is made available primarily for the benefit of the College and that if subsequent to any agreement for paid or unpaid leave, my circumstances change and I give notice of my intention to leave the College, that any agreement for such leave may be rescinded by the College.  Signature of Applicant:  FORMTEXT        FOR COMPLETION BY ASSISTANT DEAN Name of Assistant Dean FORMTEXT      Signature of Assistant Dean FORMTEXT      Date FORMTEXT       FOR COMPLETION BY EXECUTIVE DEAN Name of Executive Dean FORMTEXT      APPROVED FORMCHECKBOX  Yes  FORMCHECKBOX  NoOnly for unpaid leave  are pension costs being covered by school  FORMCHECKBOX  Yes  FORMCHECKBOX  NoSignature of Executive Dean FORMTEXT      Date FORMTEXT       Any comments  FORMTEXT        Please send a copy of this completed form to Human Resources     VVVVFVHVJVXXyhy$$7$8$H$Ifa$gdy; $7$8$H$Ifgd1_$ 7$8$H$gdnkdk$$Ifl J! t0644 lap yt{KvXXXYY $7$8$H$Ifgd1_$jkd$$Ifl J! t0644 layt1_$XXXXXXXY Y YYYYY#hGOhqE5OJQJ^JnH tH hGO5OJQJ^JnH tH huOJQJ^JnH tH  hGOh%MxOJQJ^JnH tH )jIhJOJQJU^JnH tH hJOJQJ^JnH tH #hGOhLa5OJQJ^JnH tH &hGOhLa5OJQJ]^JnH tH  hGOhLaOJQJ^JnH tH #jhJOJQJU^JnH tH *jhJOJQJU^JmHnHtH uZZ"ZJZrrxx$7$8$H$Ifgdnr{kdƈ$$Ifl0x ! t0x!644 layt1_$JZLZNZPZZZZZrriiWWxx$7$8$H$Ifgdu 7$8$H$gd&d 7$8$H$P gd{kd$$Ifl0x ! t0x!644 layt1_$ZZZZZZZZZZZZZZZ[[[ͼqZC1qq#hGOhLa5OJQJ^JnH tH -jhJ5OJQJU^JmHnHtH u,jBhJ5OJQJU^JnH tH hJ5OJQJ^JnH tH &jhJ5OJQJU^JnH tH &hnrhLa5OJQJ]^JnH tH &hGOhLa5OJQJ]^JnH tH  hGOhLaOJQJ^JnH tH  hGOhGOOJQJ^JnH tH hGO5OJQJ^JnH tH #hGOhGO5OJQJ^JnH tH ZZ[z[ooxx$7$8$H$Ifgdu}kd$$Ifl0x ! t0x!644 laytu[ ["[P[R[n[p[r[x[|[\\\ \"\$\R\T\p\r\t\z\|\~\ƯƝw`N#hGOhJ5OJQJ^JnH tH ,j0hJ5OJQJU^JnH tH ,jhJ5OJQJU^JnH tH hkQ5OJQJ^JnH tH #hGOhGO5OJQJ^JnH tH ,jhJ5OJQJU^JnH tH hJ5OJQJ^JnH tH &jhJ5OJQJU^JnH tH ,jFhJ5OJQJU^JnH tH z[|[\|\ooxx$7$8$H$Ifgdu}kd.$$Ifl0x ! t0x!644 laytu|\~\\\ooxx$7$8$H$Ifgdu}kd$$Ifl0x ! t0x!644 laytu~\\\\\\\\\\\\\]]]]]] ]0]2]4]6]ĵćuĵ^ćuO=u=#hGOhqE5OJQJ^JnH tH hGO5OJQJ^JnH tH ,j6hJ5OJQJU^JnH tH #hGOhLa5OJQJ^JnH tH -jhJ5OJQJU^JmHnHtH u,j2hJ5OJQJU^JnH tH hJ5OJQJ^JnH tH &jhJ5OJQJU^JnH tH &hnrhLa5OJQJ]^JnH tH &hGOhLa5OJQJ]^JnH tH \\\]ooxx$7$8$H$Ifgdu}kd$$Ifl0x ! t0x!644 laytu]]]2]4]\]^]`]b]d]f]h]xxxhhhhhhhx$7$8$H$Ifgd1_$ 7$8$H$gd}kd$$Ifl0x ! t0x!644 laytu 6]J]L]N]X]Z]f]h]j]l]]]]]]]]Ůş{gUC7/+/+h4jh4UhGOh5OJQJ#hGOh5OJQJ^JnH tH #hGOhLa5OJQJ^JnH tH &hGOhLa6OJQJ]^JnH tH #hGOhqE5OJQJ^JnH tH #hGOhGO5OJQJ^JnH tH hGO5OJQJ^JnH tH -jhJ5OJQJU^JmHnHtH u&jhJ5OJQJU^JnH tH ,j:hJ5OJQJU^JnH tH hJ5OJQJ^JnH tH h]j]l]]]]]]]]]^YWYWYWYgdpL1.$$d%d&d'd7$8$H$NOPQa$gdLa 7$8$H$gd@jkd$$Ifl !x! t0x!644 layt1_$ ]]]]]^^^hGOh5OJQJhnrh4jh4U]]^^^^^ ^ ^^^^^^^^.$$d%d&d'd7$8$H$NOPQa$gdLa61h/R :pGO. 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