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RTMENT DIVISION/BRANCH PERIOD OF ABSENCE FROM .. AM ON . / / . TO ....AM PM ON . ../ ./ ... PM REASON FOR ABSENCE MEDICAL CERTIFICATE ATTACHED YES NO TYPE OF LEAVE REQUIRED SICK LEAVE REPRESENTATIONAL LEAVE OTHER (SPECIFY) COMPASSIONATE LEAVE LEAVE WITHOUT PAY . SIGNATURE OF OFFICER ENSURE THAT ALL INFORMATION ../... ../ IS CORRECTLY FILLED IN AND SIGNED DATE B. FOR.
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