Leave Request

Employee’s name: Position/Title: Employee’s signature:

annual lEavE Date of Leave: From:
(first day of leave)

No. days To:
(last day of leave)

From: From: From:

To: To: To: Total number of days absent:

Manager’s approval:

pErsonal lEavE Date of Leave: From:
(first day of leave)

To:
(last day of leave)

sick leave:

or

carer’s leave:

Total no. of working days absent:

Medical Certificate supplied:

Yes:

No:

Doctor:

Manager’s approval:

othEr lEavE (eg. compassionate leave, emergency services leave etc)

Purpose of leave: From:
(first day of leave)

Date of Leave:

To:
(last day of leave)

Number of Days absent:

Leave: With Pay

With out Pay

Manager’s approval:

Version: 0.0
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© Curriculum Corporation, 2007

Updated: 11/07/07