Leave Request Form

Employee Details

• Full Name: [Insert Employee Full Name]
• Job Title: [Insert Job Title]
• Employee ID: [Insert Employee ID]
• Date of Request: [DD/MM/YYYY]

Leave Details

• Type of Leave: [ Please select one - Annual Leave / Personal Sick Leave / Carers Leave / Parental Leave / Long Service Leave / Unpaid Leave / Other ]
• Start Date: [DD/MM/YYYY]
• End Date: [DD/MM/YYYY]
• Return to Work Date: [DD/MM/YYYY]
• Total Days / Hours Requested: [Insert Total]
• Reason for Leave: [Please provide brief details, especially for personal or carers leave]

Attachments

• Supporting Evidence Attached? [ Yes / No ]
• Note: Evidence such as medical certificates or statutory declarations may be required for personal or carers leave.

Public Holidays

• Please indicate if any public holidays fall within this period and should be paid as public holidays rather than annual leave.
• Public Holiday Dates: [Insert Dates or N/A]

Contact Details During Leave

• Emergency Contact Number: [Insert Phone Number]
• Email Address: [Insert Email Address]

Employee Declaration I declare that the information provided is true and correct. I understand that I must follow company policy regarding notification and evidence for leave.

Employee Signature: __________________________ Date: __________________________

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Manager / Employer Section

Leave Balance Check

• Current Annual Leave Balance: [Insert Days/Hours]
• Current Personal Leave Balance: [Insert Days/Hours]

Decision

• Approved [ ]
• Not Approved [ ]
• Approved with Conditions [ ]

Reason for Referral or Condition (if applicable): [Insert details regarding business coverage or rescheduling]

Manager / Authorised Signature: __________________________ Date: __________________________

HR / Payroll Use Only

• Processed in Payroll: [ Yes / No ]
• Pay Period Affected: [Insert Pay Period]