category: Useful Forms

Sick Leave Self Certification Form

Name*
First Last
Brief Detail of Sickness*
Date Sickness Began*
DD slash MM slash YYYY
Date you last worked*
DD slash MM slash YYYY
Has your sickness ended?*
- No
- Yes
If yes, the date your sickness ended*
DD slash MM slash YYYY
Declaration
Name/Signature*
Date of form completion*
DD slash MM slash YYYY

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