Leave Application Form
This Form is to be received by the Phoenix Healthcare Group office at least 14 days prior to the last working day.
Occupation
*
In Office Staff Member (Unit 3a)
Home and Community Staff (Support Workers, Family Carers and Nurses)
Name
*
First Name
Last Name
Email
*
example@example.com
Payroll ID Number
Last Working Day
*
-
Day
-
Month
Year
Date
Returning to work
*
-
Day
-
Month
Year
Date
Type of leave you want to apply for:
Type of leave you want to apply for:
*
Annual Leave (please indicate how many actual hours you would normally work during this timeframe. NOTE: If there is insufficient annual leave owing but the leave could be allowed we will offer leave without pay for the remaining time)
Sick Leave - (Eligible after 6 months continuous service) You must provide a medical certificate if taking three (3) or more days off work as sick leave.
Bereavement Leave (Eligible after 6 months of continuous service, max leave can be up to 3 days)
I am not sure about leave type (please select this option if you want us to let you know what type of leave entitlement you have at this stage, our payroll team will contact you before processing your application.
Number of hours
*
Total number of hours would would normally work during the leave period
Days
*
Number of days for the leave period
Further Comments (if required)
Please upload your medical certificates (if applicable) or any other document you wish to provide.
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By signing this form, I acknowledge that should my application for leave be declined, unauthorized absence from work during the whole or any part of the period so declined will result in instant dismissal.
Staff Member Signature
*
Date
*
-
Month
-
Day
Year
Date
Please use the Innovacare app
If you are a Home and Community Staff Member (Support Workers, Family Carers and Nurses), please use the Innovacare app to apply for leave.
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