GOVERNMENT OF SAINT LUCIA

STUDY LEAVE APPLICATION FORM

APPLICATION FOR: STUDY LEAVE WITH PAY STUDY LEAVE WITHOUT PAY

SECTION A: PARTICULARS OF APPLICANT

LAST NAME: MR/MS/MRS

FIRST NAME: OTHER: Circle Appropriate

SEX: MALE FEMALE DD/MM/YY NIS #:

DATE OF BIRTH:

MAILING ADDRESS:
(Please indicate full address)

DISTRICT: Castries HOME TEL #

E-MAIL ADDRESS: OFFICE TEL #:

NAME & TEL # OF CONTACT PERSON:

SECTION B: PARTICULARS OF EMPLOYMENT

DATE OF ENTRY INTO SERVICE: (DD/MM/YY)

STAFF ID:

POSITION: GRADE/STEP:

DATE OF APPOINTMENT TO (DD/MM/YY) BASIC MONTHLY SALARY

CURRENT POSITION: (INCLUDING INCREASE): $ c

MINISTRY/DEPARTMENT:

DIVISION: EMPLOYED ON CONTRACT? YES NO

ARE YOU CURRENTLY ON STUDY LEAVE

In the last three years did you receive... YES NO
WITHOUT PAY?

TUITION REFUND YES NO ARE YOU CURRENTLY ENROLLED IN THE PROGRAMME OF STUDY? IF
YES, STATE THE ACADEMIC YEAR IN WHICH YOU ARE ENROLLED.
ECONOMIC COST YES NO

STUDY LEAVE WITH PAY YES NO ARE YOU CURRENTLY BONDED TO THE
GOVERNMENT OF ST. LUCIA ? YES NO

SECTION C: PARTICULARS OF STUDY

AREA OF STUDY:

LEVEL: POST GRADUATE

CERTIFICATE DIPLOMA BACHELOR MASTERS
DIPLOMA OTHER:
(please specify)

INSTITUTION OF LEARNING:

ACADEMIC YEAR
COUNTRY: OF INSTITUTION: MONTH: September TO MONTH: May

COMMENCEMENT EXPECTED
DATE: COMPLETION DATE: DURATION OF STUDY:
(DD/MM/YY) (DD/MM/YY)

I hereby certify that the information submitted on this application form is true and accurate.

SIGNATURE OF APPLICANT DATE

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 GOVERNMENT OF SAINT LUCIA
STUDY LEAVE APPLICATION FORM

SECTION D: TO BE COMPLETED BY THE HEAD OF YOUR MINISTRY/DEPARTMENT

1. PLEASE INDICATE WHETHER YOU SUPPORT THE OFFICER FOR STUDY LEAVE WITH OR WITHOUT PAY.

SUPPORTED NOT SUPPORTED

IF NOT SUPPORTED, PLEASE INDICATE THE REASONS

1. INDICATE THE RELEVANCE OF THE TRAINING TO THE OFFICER'S ASSIGNED DUTIES: (tick whichever applicable)

INDIRECTLY RELEVANT RELEVANT AND

NOT RELEVANT ESSENTIAL
RELATED BUT MINOR IMPORTANT

IF NOT RELEVANT, IS IT RELEVANT TO OTHER PUBLIC SECTOR AGENCIES? YES NO

PLEASE EXPLAIN:

2. HOW WILL THIS TRAINING BENEFIT YOUR MINISTRY/DEPARTMENT OR DIVISION?

3. WHAT ARE YOUR REASONS FOR SUPPORTING THE APPLICANT?

(a) INCREASE EFFECTIVENESS IN THE EXISTING JOB

(b) PROFESSIONAL STIMULATION

(c) Other
(please specify)

4. MINISTRY'S PRIORITY LEVEL IF OTHER OFFICER(S) ARE NOMINATED FOR THIS STUDY AREA: 1 2 3 4 5 (Circle
(1 - VERY HIGH, 5 - VERY LOW) appropriate)

5. WHAT ARRANGEMENTS WILL YOU MAKE TO ENSURE UTILIZATION OF SKILLS/KNOWLEDGE UPON COMPLETION OF THE COURSE?

6. HAVE SALARY PROVISIONS BEEN MADE BY YOUR MINISTRY TO MEET THE COST OF THE FIRST YEAR OF
YES NO
THE OFFICER'S STUDY ALLOWANCES? (IF APPLICABLE)

7. IN ACCORDANCE WITH CABINET CONCLUSION NO. 1643 OF 1999, INDICATE WHETHER REPLACEMENTS
ARE PROPOSED AND THE NATURE OF THE REPLACEMENT ARRANGEMENTS.

Name: Position:

Signature:
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 GOVERNMENT OF SAINT LUCIA
STUDY LEAVE APPLICATION FORM

FOR USE OF THE MINISTRY OF THE PUBLIC SERVICE ONLY

APPROVED FOR :

STUDY LEAVE WITH PAY

DD/MM/YY
CABINET CONCLUSION #: OF DATE OF CONCLUSION:

START DATE OF AWARD: DURATION OF AWARD: PERIOD OF BONDING:

DD/MM/YY

STUDY LEAVE WITHOUT PAY

COMMENCE DATE OF AWARD: EXPECTED COMPLETION DATE OF STUDIES:

DD/MM/YY DD/MM/YY

START DATE OF AWARD: DURATION OF AWARD:

DD/MM/YY

COMMENTS BY TRAINING REVIEW COMMITTEE / PERMANENT SECRETARY (PUBLIC SERVICE):

SIGNED

OTHER:

SIGNED

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