F-400 08-1-2010 Rev D

LEAVE APPLICATION
Employee Name: Employee No (if applicable):

Site: Location (e.g., Wacol):

Leave Dates
From:

To:

Leave Type Number of Days

□ Annual Leave **

□ Sick Leave

□ Rostered Days Off **

□ Public Holidays

□ Long Service Leave **

□ Unpaid Leave **

□ Other
Total Days Leave

Employee Signature: Date:

Supervisor/ Manager Name: Date Received by Supervisor/Manager:

** Is the employee apart of the Emergency response plan? Yes □ No □

If yes, ensure that the position is covered by other personnel in the sites specific Emergency Plan Command Structure
Manager’s Signature:
Date:
(for approval of leave)

Pay Office Use Only

Pd W/End Norm A/L Sick RDO P/H LSL Other Total Hrs Initials

Completed by: Date:

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