Leave Request Form

Leave Request Form
Store*
Store Email
example@example.com
Date*

DayMonthYear
Date
Hour MinutesAM/PM Option
Annual Leave provides employees with the opportunity to have a break from work and should be taken at a mutually agreed time, or as directed. For more information, please refer to the Leave Policy on metime.

Part Time

Part-time employees who are unable to work a fixed shift need to apply for leave using this form. Leave requests should be made at least three weeks before the requested time off.

Full Time & Part Time

For full-time or part-time employees, if you are absent from work due to illness or injury or due to providing care or support to a member of your immediate family who is ill or injured, a Leave Request Form should also be submitted communicating to your restaurant how your absence should be recorded; i.e. paid Personal/Carer’s leave (sick leave), unpaid leave etc.

Instructions

1. Read and complete all sections of this form;

2. Return completed request form to your Restaurant Manager.
Full name as per our records*

First NameLast Name
Employee Email Address*
example@example.com
Employee Mobile Phone #*
Type of Leave*

Annual LeaveLong Service LeaveCompassionate Leave (restaurant may request evidence)Sick Leave (restaurant may request evidence)Carer’s Leave (restaurant may request evidence)Unpaid Leave (Leave without Pay)
First Day of Leave*

DayMonthYear
Date
Last Day of Leave*

DayMonthYear
Date
Available to Return to Work Date*

DayMonthYear
Date
Number of Hours of Leave Requested*
If requesting to be paid over more than one week, please specify the number of hours to be paid per week (optional)
In the event I do not have the full amount of requested leave hours available, I authorise the business to pay the following:*

Unpaid Leave (Leave Without Pay)Long Service Leave (if available) and then Unpaid Leave (if required).
Any Additional Comments?
For sick leave, please upload a photo or scan of your medical certificate. Online Doctor's Certificates are not accepted (except Telehealth from the physical Medical Center). Only one Pharmacy Certificate accepted per calendar year.

Providing false information may result in disciplinary action.
Cancelof
By Signing Below:

1. I declare that the information in this application is true and complete;

2. I understand that this request is subject to Restaurant Manager/Consultant approval; and

3. I understand that I will be notified if my request is approved or declined.

4. I understand that and Online Doctor's Certificate is not accepted.

5. I understand that only one Pharmacy Certificate will be accepted per calendar year.

6. I understand that providing a fake medical certificate may result in disciplinary action up to and including termination.
Full Signature*

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