Leave Application
Name
*
First
Last
Email
*
example@example.com
Leave Start Date
*
/
Day
/
Month
Year
Date
Return to Work Date
*
/
Day
/
Month
Year
Date
Type of Leave
*
Please Select
Sick Leave
Carer's Leave
Leave Without Pay
Infectious Disease Leave - as per your award.
Long Service Leave
Compassionate Leave (Immediate Family) - as per your award.
Annual Leave (Children's Services Award Only)
Professional Development Absence
Other
If you have chosen 'Other', please elaborate.
Other
Please only fill this in if you seleceted 'Other'.
Relief Arrangements
*
Further Information
Signature
*
File Upload
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Choose a file
Supporting Documents, eg. Dr's Certificate etc.
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