Leave Request Form
Document Ref: AHA/HRD/F-01-08, Rev - 00, Date – 18-March-2020
Annual Leave forms must be submitted at least 4 weeks in advance.
Leave forms for all other absences must be submitted immediately upon returning to work.
[TIP: To use check boxes, double click on the box and select “Checked”].
Leave Request
Employee Name:
Position:
Type of Leave Requested
I Request A Total Of: Days Off
Leave Break Up As Follows:
Annual Leave Day/s Off Public Holiday/s Day/s Off
Compassionate Day/s Off Sick / Carer's Day/s Off [ Doctor’s Certificate ATTACHED]
Other:(Specify) Day/s Off Jury Duty Day/s Off [ JuryNoticeATTACHED]
My Last Working Day Will Be:
Leave To Commence On:
I Am Due To Return To Work On:
Reason For Leave:
Employee Signature: Date: / /
Manager Approval
Approved Rejected
Comments:
Manager Signature: Date: / /
Payroll Approval
Sufficient Leave Accrued Insufficient Leave Accrued
Entered Into Payroll System: Yes No
Payroll Signature: Date: / /