child care leave application pdf telangana letter proforma

Here is the specimen/ model proforma for child care leave application:

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 & period of that leave

Date :                                                                          Signature of applicant

Remarks of Controlling Officer/ DDO

Leave Recommended / Leave Not Recommended.

Date :                                                                            Signature
                                                                                       Designation
                                                                                        Office