致 To：九龍西聯網人力資源部 Cluster Human Resources Division（傳真 Fax：2204 1662）

（假期組 Leave Section － 瑪嘉烈醫院護士宿舍 8 樓 8/F, Nurses Quarters, PMH)）

請將此申請表連同假期申請表一起填寫及遞交
Please complete and submit this application together with your Application for Leave

九龍西醫院聯網 Kowloon West Cluster

預支年假 \ 無薪假期申請表
無薪假期申請表 Advance Leave \ No Pay Leave Application Form
第一部分 Part I（申請人填寫 To be completed by Applicant）
1. 個人資料 Personal Particulars
職員號碼 或 身份證號碼
Employee No： or HKID： X X X (X)
姓名 所屬部門及醫院 職級
Name： Dept. & Hospital： Rank：

2. 假期申請詳情 Leave Application Details

本人欲申請預支年假 或 無薪假期 ** 如下 I would like to apply for advance leave or no pay leave ** as follows：
放假前最後工作日期 由 From 至 To 日數總計 回任日期
Last Working Date (首尾兩日計算在內) (首尾兩日計算在內) Total Days Resume Duty on
before Leave (Both dates inclusive) (Both dates inclusive)
am/pm am/pm am/pm am/pm
am/pm am/pm am/pm am/pm
** Delete as appropriate

申請原因(請詳述) Reason for application (Pls describe in details) **

:

(** 請遞交有關文件以提供給醫院管理層考慮及批核上述申請，例如到外地進修，可提供入學證明信或簽證等文件。 You are

encouraged to submit supporting documents for hospital management for consideration of the above application e.g. admission letter \
visa etc. for studying aboard)

如我於離職時仍未賺回足夠的年假，
如我於離職時仍未賺回足夠的年假，我同意須向醫管局以現金償還該預支的年假， 我同意須向醫管局以現金償還該預支的年假，金額以離職時最後支取的工資
計算。
計算。If I leave the service before having earned the leave I applied for, I undertake to reimburse the HA any advance
leave taken calculated at my last drawn wages.
簽署 日期
Signature: Date:

第二部分 Part II（由部門主管填寫 To be completed by Head of Department）

以上申請
獲推薦 is recommended (
請在合適的空格上  Please tick as
The above application
不獲推薦 is not recommended appropriate)
其他意見（如有）
Comments (if any)：

姓名 簽署
Name: Signature:
職級 聯絡電話 日期
Rank: ： Tel. No. Date：

請注意 Note：i) 根據人力資源政策手冊第 F1.5.2 章，申請人最多只可申請 12 個工作天（下一年度的年假）的預支假期，

並必須先放取所有假期餘額，包括轉職醫管局的儲備假。 According to HRPM F1.5.2, applicant can apply an advance of
annual leave up to 12 working days of next year, on the condition that the employee has used up all his/her leave balance

預支年假並不適用於按臨時聘用或未通過試用期的員工。
including any sinking leave carried over to HA.
ii) Application for advance leave is not applicable to staff on
temporary terms and not yet passed probation

KWC-CHR-Form-L&T-014-v002(10.07.2014)