Leave Request

Employee’s name:

Position/Title:

Employee’s signature:

ANNUAL LEAVE No. days

Date of Leave: From: To:
(first day of leave) (last day of leave)

From: To:
From: To:
From: To:

Total number of days absent:

Manager’s approval:

PERSONAL LEAVE
Date of Leave: From: To:
(first day of leave) (last day of leave)

Total no. of working

Sick leave: or Carer’s leave: days absent:

Medical Certificate supplied: Yes: No: Doctor:

Manager’s approval:

OTHER LEAVE (eg. compassionate leave, emergency services leave etc)

Purpose of leave:

Date of Leave: From: To:

(first day of leave) (last day of leave)

Number of Days absent: Leave: With Pay With out Pay

Manager’s approval:

Version: 0.0 © Curriculum Corporation, 2007 Updated: 11/07/07

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