Applicants Name Job Title Date of Application of Dependant Care Leave No Of Days Taken Working Pattern (please enter no. of contractual hours on each day normally worked) ***Please ensure this section is fully completed*** Paid Dependant Care Leave is at the discretion of the Head Teacher or Trustees (if appropriate). Please refer to guidance on Leave of Absence in Staff Handbook. Reason for Dependant Care Leave Do you wish to apply for payment for the YES NO period of your Dependant Care Leave? No of Days Previously for Dependant Care Leave If you wish to apply for payment for your period of Dependant Care Leave please give details of how you tried to minimise your time absent from work. Signed: For Headteacher’s use: Application discussed with Governors: YES NO Application for leave: APPROVED REJECTED Approved PAID UNPAID Reason for Decision Signed: Date:
Applicants Name Job Title Date of Application of Dependant Care Leave No Of Days Taken Working Pattern (please enter no. of contractual hours on each day normally worked) ***Please ensure this section is fully completed*** Paid Dependant Care Leave is at the discretion of the Head Teacher or Trustees (if appropriate). Please refer to guidance on Leave of Absence in Staff Handbook. Reason for Dependant Care Leave Do you wish to apply for payment for the period of your Dependant Care Leave? YES NO No of Days Previously for Dependant Care Leave If you wish to apply for payment for your period of Dependant Care Leave please give details of how you tried to minimise your time absent from work. Signed: For Headteacher’s use: Application discussed with Governors: YES NO Application for leave: APPROVED REJECTED Approved PAID UNPAID Reason for Decision Signed: Date:
Ebor-Academy-Trust-Request-for-Dependant-Care-Leave.docx