Additional Hours Application
Name
*
First
Last
Email
*
example@example.com
Week Beginning
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Reason
*
Please Select
Relief (please note the Early Childhood Service in 'Other')
SRF
SRF - Allied Health
PDP
NERPSA Requested Meeting
Service Staff Meeting
Pre Approved Professional Development
Staff Orientation
Open Days/Transition Days
Start of Year Award Admin Days
End of Year Award Admin Day
Other
If you have chosen 'Other', please ensure it is preapproved and you attach supporting documentation.
Other
Please only fill this in if you selected 'Other' for Reason, or if you selected Relief.
Further Information
Monday
Hour Minutes
AM
PM
AM/PM Option
to
until
Hour Minutes
AM
PM
AM/PM Option
Tuesday
Hour Minutes
AM
PM
AM/PM Option
to
until
Hour Minutes
AM
PM
AM/PM Option
Wednesday
Hour Minutes
AM
PM
AM/PM Option
to
until
Hour Minutes
AM
PM
AM/PM Option
Thursday
Hour Minutes
AM
PM
AM/PM Option
to
until
Hour Minutes
AM
PM
AM/PM Option
Friday
Hour Minutes
AM
PM
AM/PM Option
to
until
Hour Minutes
AM
PM
AM/PM Option
Total Additional Hours
Upload supporting documents if needed.
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