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Child Care Leave (CCL) Application Form

For Women Employees of State Govt.

Instructions:

  • Fill out the form parts completely. No fields are strictly mandatory, but ensure accuracy.
  • Your progress is auto-savable via the "Save Draft" button.
  • Child age (18 years) and Leave Days are auto-calculated for your convenience.
  • Click "Generate Application" to view, print, or download a perfectly formatted A4 document.
Ready to start...
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Part 1: Applicant Details

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APPLICATION FORM FOR CHILD CARE LEAVE
(FOR WOMEN EMPLOYEES OF STATE GOVT.)
1.
Name of Applicant
:
2.
Designation
:
3.
Department/Office/Section
:
4.
Detail of the Children
:
Sl. No.
Name
Date of Birth
1.
2.
5.
Name of Child for whom Child Care
Leave is required and applied for
:
6.
Date of Birth of the Child
(Attested copy of Birth Certificate
to be enclosed)
:
7.
Date on which child will be
Attaining 18 Years
:
8.
Is the Child among the two eldest
Children (Yes/No)
:
9.
Period of Leave
Days
Prefix/Suffix of holidays, if any
:
From
to
10.
Reason (s) for leave applied for
:
11.
Total child Care Leave availed till date
a)   In the current year (separated
      for each spell)
:
b)   Cumulative total in service
      till date
:
12.
Whether permission to leave station
is required (Yes/No)
:
•   If yes, Address during leave
      Period
:
13.
Date of return from last leave &
nature and period of that leave
:
Date
:
SIGNATURE OF APPLICANT
Remarks of Controlling Officer
Leave recommended / Leave not recommended
Date
:
Signature
:
Designation
:
Office
:
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