The purpose of this form is to provide evidence as required by section 8.2 of the PG010 Leave Policy.

F0125 LEAVE EVIDENCE SUBMISSION FORM
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PURPOSE

The purpose of this form is to provide evidence as required by section 8.2 of the PG010 Leave Policy.
EMPLOYER*

Westside Bus Co Pty LtdPark Ridge Admin Pty LtdBus Queensland (Lockyer Valley) Pty LtdToowoomba Admin Pty LtdCranbourne Transit Admin Pty LtdMansfield-Mt Buller Bus Lines Pty Ltd
Abbrev
EMPLOYEE DETAILS
First Name*
First Name
Last Name*
Last Name
Employee No.*
Employee No.
Email*
Please enter a valid email address
PERSONAL LEAVE REQUEST
Commencement of leave

DayMonthYear
Date
End of leave

DayMonthYear
Date
Dummy Date

DayMonthYear
Date
Day of the week
DECLARATION
I declare that the information which I have provided above is full and correct to the best of my knowledge. I acknowledge that my employer may direct me to provide additional information, should any further information be required. I understand that if I provide false or misleading information, this may lead to disciplinary action being taken against me, up to and including termination of my employment.
Employee Signature*

Clear
Date*

DayMonthYear
DOCUMENT UPLOAD*

Multiple submissions accepted
Cancelof
Should be Empty:

F0125 LEAVE EVIDENCE SUBMISSION FORM