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Annual leave and long service leave application form

This form is for employees to use to apply to take annual leave or long service leave. For more information about leave entitlements and obligations, visit

Employees details
First name: Surname: Position: ontact phone number:

Leave type
Please tick the appropriate box(es). If you are applying for more than one type of leave, please specify the details in the comments section provided.

!nnual leave "full pay# !nnual leave "half pay# !nnual leave in advance
Note: pon termination of employment, leave taken that has not been accrued can be !ithheld from !ages.

$eave without pay $ong service leave omments:

Period of leave
$ast day of work: %eturn to work date: Total number of working days off:
Note: "o not include any #"$s, public holidays, or substituted days in the total.


Signature of employee:&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

'ate:&&&&&&&&&&/&&&&&&&&&&&&&/ &&&&&&&&&&&&

Approval of leave (to be completed by manager/supervisor)

!pproved (ot approved %eason for refusal (if applicable):

(ame of manager/supervisor:

Signature of manager/supervisor:&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

'ate:&&&&&&&&&&/&&&&&&&&&&&&&/ &&&&&&&&&&&&

,eep a copy of this form as a record and ensure you advise your employees if you approve or do not approve their proposed leave. -ou cannot unreasonably refuse an employee.s re/uest to take paid annual leave.

%he &air 'ork $mbudsman is committed to providing you !ith advice that you can rely on. %he information contained in this template is general in nature. If you are unsure about ho! it applies to your situation you can call our Infoline on () () *+ or speak !ith a union, industry association or a !orkplace relations professional.