Full time and Part Time Staff Leave Request Form

Full time and Part Time Staff Leave Request Form
What state do you work in?*

VictoriaQueensland
Name*

First NameLast Name
Work Title*
Email*
Phone number*
Leave details*
Other (if applicable)
Doctor/Stat Dec Certificate attached*

YesNoLaterNot applicable
If certificate not provided, please provide a reason.
Doctors Certificate

Cancelof
Date Sent*

DayMonthYear
Signature*

Clear
Note: Approval of the leave form does not guarantee payment; payment depends on the leave balance at the time that the leave is taken, this balance can change in between the leave request being approved and the leave being taken/paid.

No paid leave (sick or annual) will be processed without an approved Leave Request Form.
Submission request comments
Should be Empty: