UHCM EMPLOYEE - APPLICATION FOR LEAVE FORM
Employee Name:
*
First Name
Last Name
Email:
*
example@example.com
Date Leave From:
*
-
Day
-
Month
Year
Date
Date Leave To:
*
.
Day
.
Month
Year
Date
Total Number of Days/Hours
*
(please specify hours or days)
Reason for Leave:
*
Type of Leave Requested
*
Please Select
Annual Leave
Personal Leave (sick)
Unpaid Leave
Long Service Leave
Time in Lieu
Paid Parental Leave
Details of lessons missed/made up:
*
Employee Signature:
*
Today's Date
-
Day
-
Month
Year
Date
Submit
Should be Empty: