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Emergency Leave or Holiday Request Form
First name
*
Last name
*
Birthday
*
Day
Month
Year
Email
*
Phone
*
Workplace name and address:
*
Job title:
*
Employer or contractor name:
*
Type of leave requested:
*
Paid holiday
Unpaid emergency leave
Start date of leave:
*
End date of leave:
*
Total number of days requested:
*
Is the reason related to a personal, family, illness, or medical emergency?
*
Personal
Family
Illness
Medical
Other
Have you already taken any leave this year?
*
No
If yes, please specify the dates
How many days of annual holiday entitlement do you have remaining?
*
Has your employer already approved or rejected any part of this request?
*
Approved
Rejected
Pending
Do you have any supporting documents for your request (e.g., medical certificate, proof of emergency)?
*
Yes
No
When do you expect to return to work?
*
Is there anything else you would like to add regarding your request?
*
Please ensure that any supporting documents or evidence are sent to CAIWU staff for review.
Submit
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