<p> THE CHINESE UNIVERSITY OF HONG KONG APPLICATION FORM FOR LEAVE OF ABSENCE (for appointees on Terms of Service (A) / (HA) or equivalent) Notes to Applicants (1) The personal data provided on this Form will be used by the Personnel Office and the Department/Unit concerned for considering applications for leave of absence. (2) Applicants should read the relevant University regulations governing the type(s) of leave applied for before completing this Form. The provision of personal data on this Form is voluntary. If you do not provide sufficient information, however, we may not be able to process your application. (3) For enquiries, including data access and corrections, please contact the Personnel Office at 3943 7292 / 3943 7291 / 3943 7232 / 3943 1955 / 3943 7332 or the Department/Unit concerned. Section A Part I: Personal Particulars</p><p>1. Staff ID: ______2. Name: 3.Tel.: </p><p>4. Post: 5. Department/Unit: </p><p>Part II: Leave Particulars [Please attach relevant documents where appropriate]</p><p>6. Types of leave applied Leave Period Type of Leave from [dd/mm/yy] to [dd/mm/yy] Duration</p><p>(i) ______| / / | | / / |</p><p>(ii) ______| / / | | / / |  Application for conference grant should be made separately on the Application Form for Conference Grant.</p><p>7. (For teaching appointees) I am a Principal Investigator (PI) of ongoing RGC grant(s): Yes*□ No □ * If the leave period under application is for a continuous period of 1 month or longer, please solicit the endorsement of the Chairperson of the Research Committee in Section B via the Research Administration Office.</p><p>8. Reasons/Justifications (if applicable): </p><p>9. In case I have taken long leave, annual leave or vacation leave in excess of my earned leave balance by the time I leave University service, I understand and agree that I have to repay to the University an amount calculated in accordance with the applicable leave scheme rules and University regulations.</p><p>Date: / / [dd/mm/yy] Signature: ______</p><p>Section B [Applicable to teaching appointees who are PIs of ongoing RGC grant(s)]</p><p>10. Endorsement by the Chairperson of Research Committee or his/her delegate (please “” as appropriate): □ Endorsed □ Not Endorsed Remark, if any: </p><p>Date: / / [dd/mm/yy] Signature/Post: / (Name: ) Section C</p><p>11. Endorsement by Department Chairman / Unit Head (if applicable) (please “” as appropriate): □ Endorsed □ Not Endorsed Remark, if any: </p><p>Date: / / [dd/mm/yy] Signature/Post: / (Name: ) Section D</p><p>12. Approval / Recommendation by Faculty Dean / Department Chairman / Unit Head / Director of Research Institute / Supervising Officer (please “” as appropriate): □ Application approved/recommended for University approval. □ Application not approved</p><p>Date: / / [dd/mm/yy] Signature/Post: / (Name: ) Note: Application will be submitted to the relevant Committee if required under the University regulations. P/LVE/A/HA(11/13)</p>