Carry Over of Annual Leave
Application Form – HR 108 (r)
In exceptional circumstances due to service requirements, annual leave may be
carried forward into the first six months of the next annual leave year, provided
the employee agrees to defer his/her leave.
Please complete in Block Capitals/Tick appropriate boxes.
Section 1. To be completed by the employee
Surname: First Name:
Grade: Personnel No:
Location: PPS No:
In accordance with the provisions of the HSE Terms and Conditions of Employment (Revised) 2009.I hereby notify
my employer that I intend to carry over Annual Leave.
Number of days carried over Number of hours carried over
Reason for the carry over of annual leave:
Signature: Date:
Section 2.To be completed by the Line Manager
I have checked the relevant supporting documentation required for the leave requested and confirm that the leave
required complies with the terms outlined in the relavant HR policy
Application Approved Yes No
Signature: Date
Name: Grade:
Contact Phone No: Mobile No:
Email Address:
Section 3.To be completed by Human Resources Personnel Administration
System updated by: Name:
Contact Phone No: Date:
Section 4.Circulation List
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HR108 (r)_V2 Apr 2010 Page 1 of 1 Revised 01/04/2010
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