Lay Employee Application For Leave Form

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Please note:
While an employee will generally have discretion in nominating when he/she takes annual leave,
Managers/Supervisors may request that an employee take annual leave at a time more convenient to
the operations of the organisation.
Name of Employee: __________________________________________________________________________________
Position: ________________________________________
Department: ____________________________________
Available leave confirmed with Payroll: __________________________________________________________________
Leave required (please tick the appropriate box)
Annual leave
Personal leave (sick/carers leave)
Compassionate leave (bereavement and special leave)
Long service leave
Parental leave
Other (jury duty, study leave)
Reason for compassionate or unpaid leave
Date(s) for leave
Commence leave on: ______________________________
Number of days/hours: ___________________________
Last day of leave: _________________________________
Less public holidays: ______________________________
Total days leave required: _________________________
I understand that if I have insufficient leave to cover this application, the balance of leave requested will result in a
temporary ‘negative balance’ of leave entitlements that may require reimbursement should I leave the employment of
the Diocese.
Employee Signature: ______________________________
Date: __________________________________________
Have arrangements been made to cover your position whilst on leave?
Authorised by: ______________________________________________________________________________________
Please forward leave form to HR at Diocesan Office, Perth
Note: For annual leave please notify by end of month before required date
Updated September 2014


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Parent category: Business