Security Level: Public

Application for Leave

Employee Number 19816 Employee Name Prajwal Basnet

Date 30/05/24 Home Greenwood

Leave Details (please tick appropriate leave)

☐ Annual Leave ☐ Unpaid Study Leave (Refer to LWOP Policy)

☐ Study Leave ☐ Other, please specify:

☐ Public Holiday Elect
☐ Personal Leave ☐ RDO
☐ Sick Leave ☐ Extra Leave
☐ Certificate attached ☐ Community Services
☐ Carers Leave ☐ Representatives Leave (Union Letter Required)
☐ Certificate attached ☐ Ceremonial
☐ Unpaid Sick Leave (Refer to LWOP Policy) ☐ Purchased Annual Leave (Previous purchase
☐ Certificate attached leave agreement must be in place)

☐ Compassionate Leave ☐ Leave without Pay (Refer to LWOP Policy)

Use full date e.g. Monday 1st October 2015.

Staff at the Homes need to attach a timesheet as per their normal rostered hours for the period of leave
First Date of Absence 28/05/24 Last Day of Absence 03/06/24

Hours of Leave Taken Public Holiday Hours

Day and Date of Total Number of

04/06/24
Return to Work Business Days Absent

Employee Signature Prajwal Date 30/05/24

Approval (to be completed by employees Manager)

Leave Approved (circle) YES / NO. If no, please specify reason:

Manager Signature Date

Payroll Department Use Only

Paid YES / NO. If no, please specify reason:

Signature Date

Document Name: Application for Leave Page: 1 of 1

Document ID D100-15-3247
Version Date: 15/01/2019 Version Number: V2.2