TEACHERS SERVICE COMMISSION

TO BE COMPLETED IN TRIPLICATE

The TSC County Director                                                                  School Address

…………………………………….                                                        ……………………………………

1. O. Box ………………… P. O. Box ………………………..

…………………………………….                                                                                                                        ……………………………………..

Through’

The Principal/Headteacher

…………………………………..

1. O. Box………………………..

…………………………………..

RE:      APPLICATION FOR MATERNITY LEAVE

PART I

I Mrs./Miss                                                                                                         TSC No.                                  Wife of                                                                                                    do hereby apply for three (3) months maternity leave with effect from                             as per Doctor’s certificate.

Date:                                                                                                                                                                            

Applicant’s Signature

PART II

TO BE COMPLETED BY MEDICAL OFFICER

I hereby certify that I have this day examined Mrs./Miss                                                                                                                                                                                                                                                  and that her date of conferment will approximately be on                                                                                                                                                                                     . Any alteration made in the certificate should be in initialed by the Doctor.

Date:                                                        

NOTE:

Signature:                                                        Name:         Stamp:             

1. Application should be submitted at least one month before the leave starts
2. A woman teacher who avails herself for maternity leave will for annual leave for that year
3. Submit the birth notification before you resume

HUMAN RESOURCE MANAGEMENT OFFICE

TEACHERS SERVICE COMMISSION KENYA IS ISO 9001:2008 CERTIFIED