Annual Leave and Long Service Leave Application Form

Annual Leave and Long Service Leave Application Form

Employee's Details
Employee Name
Name
Surname
Position
Phone Number

Area CodePhone Number
Leave Type
Please tick the appropriate box(es). If you are applying for more than one type of leave, please specify the details in the comments section provided.
Annual leave (full pay)Annual leave (half pay)Annual leave in advanceLeave without payLong service leaveRostered Day Off
Comments
Period of Leave
Last day of work
Return to work date

MonthDayYear
Date
Total number of working days off
Comments
Signature of employee
Date

MonthDayYear
Date
Approval of leave (to be completed by manager/supervisor)
ApprovedNot approved
Reason for refusal (if applicable)
Name of manager/supervisor
Signature of manager/supervisor
Date

MonthDayYear
Date
Should be Empty: