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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