ࡱ>  Nbjbj@@ Cy* k* k U( ( !!!!!5558m5DvW!!H;D=D=D=D=D=D=DG8J|=DQ!+""+"+"=D!!D$$$+"F!!;D$+";D$$R1?B q"%@'DD0DC@J"J<BB&J!7B+"+"$+"+"+"+"+"=D=D#p+"+"+"D+"+"+"+"J+"+"+"+"+"+"+"+"+"( : Application for Leave for Public Duties/Service in the Volunteer Reserve Forces Please discuss your leave request with your line manager/supervisor and refer to the HYPERLINK "/human-resources/leave/special-leave/"Special Leave Policy before completing this form. Please send the completed form to the HYPERLINK "/human-resources/operational-services/ask-staff-hub/"Staff Hub, retaining a copy for your own records. Prior to submitting application, please liaise with the HYPERLINK "https://www.imperial.ac.uk/human-resources/operational-services/ask-staff-hub/"Staff Hub to clarify the impact of your leave (if approved) on your pension. Section 1: To be completed by ApplicantCID:  FORMTEXT      Title:  FORMTEXT      Surname:  FORMTEXT      First Name(s):  FORMTEXT      Dept/Div/Sch/Inst:  FORMTEXT      Section/Group:  FORMTEXT       Section B: Leave RequestI wish to apply for the following category of Special Leave:Leave for Public Duties FORMCHECKBOX Leave for Service in the Volunteer Reserve Forces* *If request relates to notification of mobilisation for full-time service with the Regular Forces, please contact the Staff Hub as soon as possible FORMCHECKBOX  Additional details (specify dates requested, duration and reason for request) FORMTEXT       Details of leave being requestedDate leave to start: FORMTEXT      Date leave to end: FORMTEXT      Total no. of days requested: FORMTEXT      Total no. of days to be unpaid:* *Please note, if a period of approved Special Leave is wholly or partly unpaid, this will result in a deduction to your salary. FORMTEXT       Please provide details of special leave already taken in the category checked above, during the preceding 12 month periodDateReason for LeaveTime take<AEOPQ & 䱱䣒}lT}A}$hf.hD0JCJOJQJ^JaJ/jhf.h:[CJOJQJU^JaJ hf.h:[CJOJQJ^JaJ)jhf.hXCJOJQJU^JaJ hf.hDCJOJQJ^JaJhuhD5OJQJ^J/hB*CJ$KHOJQJ^JaJ nHphtH5huhB*CJ$KHOJQJ^JaJ nHphtH5huhDB*CJ$KHOJQJ^JaJ nHphtHPQ' ( B ojkdW$$Ifl#$ t0644 laytJd$Ifgdf. dgdf. $da$gdl & ' ( / 3 J N O 0 2 ˶ziWE.,jhf.hZ,CJOJQJU\^JaJ#hf.hDCJOJQJ\^JaJ#hf.hXc6CJOJQJ^JaJ hf.h0CJOJQJ^JaJ$hf.h70JCJOJQJ^JaJ/j hf.h:[CJOJQJU^JaJ hf.h:[CJOJQJ^JaJ)jhf.hZ,CJOJQJU^JaJ hf.h7CJOJQJ^JaJ hf.hXcCJOJQJ^JaJ#hf.hD6CJOJQJ^JaJ2 < P ` Ӽ{n\J\J99 hf.hDCJOJQJ^JaJ#hf.h =`5CJOJQJ^JaJ#hf.hD5CJOJQJ^JaJhf.hDOJQJ^J4hf.hDB*CJKHOJQJ\aJnHphtH#hf.hDCJOJQJ\^JaJ'hf.hZ,0JCJOJQJ\^JaJ,jhf.hZ,CJOJQJU\^JaJ2j0hf.h:[CJOJQJU\^JaJ#hf.h:[CJOJQJ\^JaJ        0 2 4 6 8 : < > ɱږڅpXp=====4jhf.hL CJOJQJU^JaJmHnHu/jEhf.hL CJOJQJU^JaJ)jhf.hL CJOJQJU^JaJ hf.hDCJOJQJ^JaJ4jhf.hhCJOJQJU^JaJmHnHu/jhf.hhCJOJQJU^JaJ hf.hhCJOJQJ^JaJ)jhf.hhCJOJQJU^JaJ hf.hL CJOJQJ^JaJ> @ B D T V X l n p r t v x z | ~  Ȱꕕ}ꕕl hf.h =`CJOJQJ^JaJ/jhf.hL CJOJQJU^JaJ4jhf.hL CJOJQJU^JaJmHnHu/jAhf.hL CJOJQJU^JaJ hf.hL CJOJQJ^JaJ hf.hDCJOJQJ^JaJ)jhf.hL CJOJQJU^JaJ$B D ~ ssd$Ifgdf.}kd$$Ifl0!# t0644 layt =`  Z ssd$Ifgdf.}kd)$$Ifl0!# t0644 layt        0 2 4 H J L N P R T V X Z \ ^ t ҷҦҕ}ҷҦiiiXXXXXXX hK hCJOJQJ^JaJ&hK h5CJOJQJ\^JaJ/j3hf.hL CJOJQJU^JaJ hf.hL CJOJQJ^JaJ hf.hDCJOJQJ^JaJ4jhf.hL CJOJQJU^JaJmHnHu)jhf.hL CJOJQJU^JaJ/jhf.hL CJOJQJU^JaJ"Z \ ^ |i$Ifgdf.l gdf.}kd$$Ifl0!# t0644 layt hkd$$Ifl#$ t0644 laytK $Ifgdf.l hkdg$$Ifl#$ t0644 laytK  !-./012YZdej~     Z[\ɱɅt````&hK h5CJOJQJ\^JaJ hf.hCJOJQJ^JaJ/jH hK hf.CJOJQJU^JaJ&hK h6CJOJQJ]^JaJ/jQ hK hf.CJOJQJU^JaJ hK hf.CJOJQJ^JaJ)jhK hf.CJOJQJU^JaJ hK hCJOJQJ^JaJ"12e [{kd $$Ifl0# t0644 laytK $Ifgdf.l  & F $IfgdK l    [l$Ifgdf.l gdf.{kd $$Ifl0# t0644 laytK [\$Ifgdf.l hkd? $$Ifl#$ t0644 laytK \]ghi  RTV~ꦦٕpp[pC[/j hK hwCJOJQJU^JaJ)jhK hwCJOJQJU^JaJ hK hwCJOJQJ^JaJ&hK hw5CJOJQJ\^JaJ hf.hCJOJQJ^JaJ4jhK hCJOJQJU^JaJmHnHu/j hK hCJOJQJU^JaJ hK hCJOJQJ^JaJ)jhK hCJOJQJU^JaJT}$Ifgdf.l gdf.jkd( $$Ifl#$ t0644 laytK TV$Ifgdf.l hkd $$Ifl#$ t0644 laytK 246JLNPRTVXZ\^txпЮпЮ~пj&hK hw6CJOJQJ]^JaJ/jhK hwCJOJQJU^JaJ/j hK hwCJOJQJU^JaJ hK hwCJOJQJ^JaJ hK hCJOJQJ^JaJ)jhK hwCJOJQJU^JaJ4jhK hwCJOJQJU^JaJmHnHu)qq$Ifgdf.l {kd $$Ifl0J # d t0644 laytK 4\qq$Ifgdf.l {kd$$Ifl0J # d t0644 laytK \^qqq$Ifgdf.l {kdx$$Ifl0J # d t0644 laytK lVƮדׂq]]]]LLL hK h" BCJOJQJ^JaJ&hK h" B5CJOJQJ\^JaJ hf.hCJOJQJ^JaJ hK hCJOJQJ^JaJ4jhK hwCJOJQJU^JaJmHnHu/jhK hwCJOJQJU^JaJ hK hwCJOJQJ^JaJ)jhK hwCJOJQJU^JaJ&hK hw6CJOJQJ]^JaJl$Ifgdf.l gdf.{kdo$$Ifl0J # d t0644 laytK H$Ifgdf.l hkd$$Ifl#$ t0644 laytK HHH H"H6H8H:HH@HBHDHFHHHJH^H`HbHdHfHhHjHlHnHpHrHHHHHHHHHHHHǔ|ǔdǔ/jhK h" BCJOJQJU^JaJ/j^hK h" BCJOJQJU^JaJ4jhK h" BCJOJQJU^JaJmHnHu/jhK h" BCJOJQJU^JaJ)jhK h" BCJOJQJU^JaJ hK hwCJOJQJ^JaJU hK h" BCJOJQJ^JaJ'n (hours/days) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Section C: ApprovalEmployee s declaration:I confirm that: I wish to apply for Special Leave as detailed in Section B above; I understand that, if the leave is partly, or fully unpaid, this will result in a deduction to my salaryName:  FORMTEXT       Date:  FORMTEXT      Confirmation of approval (to be completed by line manager):I confirm that the Special Leave request outlined at Section B has been approvedName:  FORMTEXT       Date:  FORMTEXT            SHAPE \* MERGEFORMAT  People Function Updated March 2026 H HHHpHHq^^^$Ifgdf.l kdg$$IflF #   t06    44 laytK HHHHIq^^^$Ifgdf.l kdF$$IflF #   t06    44 laytK HHHHHHHHHHHHHHHHHHHHHHHHIIIII I IIIIII*Iꦦ}ꦦeꦦꕕ/jhK h" BCJOJQJU^JaJ/j=hK h" BCJOJQJU^JaJ hK hwCJOJQJ^JaJ4jhK h" BCJOJQJU^JaJmHnHu/jhK h" BCJOJQJU^JaJ hK h" BCJOJQJ^JaJ)jhK h" BCJOJQJU^JaJ$IIIRITIVIXIZI\I^I`IbIdIfIzI|I~IIIIIIIIIҷҦҕ}ҷҦҕeҷҦ/jhK h" BCJOJQJU^JaJ/jhK h" BCJOJQJU^JaJ hK h" BCJOJQJ^JaJ hK hwCJOJQJ^JaJ4jhK h" BCJOJQJU^JaJmHnHu)jhK h" BCJOJQJU^JaJ/jhK h" BCJOJQJU^JaJ IIIIqlY$Ifgdf.l gdf.kd$$IflF #   t06    44 laytK IIIIIIIIIIII JJ`KbKdKpKrKKKKKKKKKKKKKKKKKKKKKKKKʵʝʵj/jZhK h" BCJOJQJU^JaJ4jhK h" BCJOJQJU^JaJmHnHu/jhK h" BCJOJQJU^JaJ)jhK h" BCJOJQJU^JaJ hK h" BCJOJQJ^JaJ&hK h" B5CJOJQJ\^JaJ hf.hwCJOJQJ^JaJ)IIIIhkd$$Ifl#$ t0644 laytK $Ifgdf.l hkd$$Ifl#$ t0644 laytK I JJbKdKKKnhkdq$$Ifl#$ t0644 laytK  & F $IfgdK l $Ifgdf.l KKK*L2LDLFLHLTL^LLLLLLMMMMMMMMM M,M.MBMDMFMHMJMLMNMPMRMTMVMXMƓ{Ɠj hf.h" BCJOJQJ^JaJ/jhK h" BCJOJQJU^JaJ4jhK h" BCJOJQJU^JaJmHnHu/j-hK h" BCJOJQJU^JaJ)jhK h" BCJOJQJU^JaJ&hK h" B5CJOJQJ\^JaJ hK h" BCJOJQJ^JaJ&KKFLHLhkdC$$Ifl#$ t0644 laytK $Ifgdf.l hkd$$Ifl#$ t0644 laytK HLLL MTMnn$Ifgdf.l hkd$$Ifl#$ t0644 laytK  & F $IfgdK l TMVMXM\M^MbMdMhMjMnMpMrMtMvM}{^gd:[ dgdEgdf.hkd$$Ifl#$ t0644 laytK XMZM\M^M`MbMdMfMhMjMlMnMpMrMtMvMxMMMMMMMMMMMMNNNŽ hf.h" BCJOJQJ^JaJhmhUPh|=ht`<jha:Ujh:[UmHnHuh:[jh:[Uh{hEhK jhK UvMMMMMMNNNgdf. dgdt`<$ B#`a$gdt`<? 0P1h:p:[. 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