Form 3 - Annual Leave Record

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Annual Leave Record Card (Form 3)

Employee Name Employer Name Annual Leave Entitlement Hours

Date of Period of Leave Number of Balance Cover Cover Initials Date


Request Working of Requested Arranged
From To Hours Hours
Employee Name Employer Name Annual Leave Entitlement Hours

Date of Period of Leave Number of Balance Cover Cover Initials Date


Request Working of Requested Arranged
From To Hours Hours

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