Vacation request form

Personal details

Full name*

Email address*

Planned vacation

Last working day before vacation*

First working day after vacation*

Amount of calendar days during vacation*

1-7
8-14
15-21
22-28
29 or more

HollandZorg

Do you want to continue your HollandZorg during your vacation?*

Yes - Be aware that the health insurance premium will be deducted from the last salary before your vacation. Per vacation week a sum of €38,00 is withheld
No - Be aware that your health insurance will be stopped during the vacation. It will end 2 days after your vacation starts, so your trip home is insured
I am not insured at HollandZorg through TecLine

Vacation reason

Reason for vacation request*

Paid vacation leave - The number of accumulated paid vacation days can be found on your payslip
Special leave - wedding, birth, funeral, moving, etc. according to labour agreement. Only accepted after relevant documents are supplied
Unpaid vacation leave - non-working days during requested vacation are unpaid

Paid vacation leave

I agree to take unpaid vacation leave when the requested vacation exceeds the number of accumulated paid vacation days

Vacation approval

Please discuss your vacation plans with the client you are working for, before submitting your request to TecLine. Only after the client has agreed on the holiday plans, your vacation can be approved by TecLine

Is your vacation approved by the client?*

Yes
No

Full name clients contact person*

Reason that your vacation is not approved*

Email

Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.