Leave Application Form
This form is for employees to apply for annual or long service leave. For more information about leave entitlements and obligations, visit www.fairwork.gov.au/leave
Staff member asking for time off
*
First Name
Last Name
Position within Business
Eg. Retail assistant, Butcher etc.
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Leave Type
*
Please Select
Annual Leave (Full pay)
Annual Leave (Half pay)
Annual Leave (In advance)
Leave without Pay
Long Service Leave
Other
Note: For annual leave in advance, upon termination of employment, leave taken that has not been accrued can be withheld from wages.
Other, Please Specify
Please specify type of leave you are applying for.
What is your first day of requested leave?
*
-
Day
-
Month
Year
Date
When is your requested return to work date?
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Comments
Signature
*
Continue
Continue
Should be Empty: