Leave Form

Application for Leave Form

Employee Details

Date

Work Location *

Name *

*Start typing your name and select from the dropdown to auto-populate employee ID and email.

Employee # *You can find this 4 digit number on your Payment Advice, in front of your name.

Email *

Shift Worker *

YesNo

Leave Request Details

Was this leave taken in the past? *

YesNo

Contact method

Contactable by Email

Contactable by Mobile

Who should we contact while you are out of the office?

Other Leave Type - please provide details

Upload Supporting Documents (if any)

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Upload Medical Certificate

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*For periods of personal or carer leave exceeding two days, a medical certificate may be required.

Additional information (if any)

Contact details whilst on leave in case of emergency *

Approving Supervisor Email *

*This application will go to this email address for approval.

Period of Leave

Bonus leave is not intended to replace personal/carers leave and will not be approved for that purpose. Requests for Bonus leave should be submitted at least 14 days in advance.

Leave Without Pay greater than ten (10 days) will only be granted when all annual leave and long service leave owing have been exhausted unless approved in writing by an EGM.

Long Service Leave

Long Service Leave can only be taken in blocks of 20 days, with a minimum of 4 weeks and a maximum of 12 weeks. Request for Long Service Leave must be submitted at least 2 months in advance.

For more information, please refer to ADG Long Service Leave policy.

Total number of working days/hours **Please specify leave hours if you are taking a part-day leave.

Total number of working days *

First day of leave *

Last day of leave *

*Error!!! Last day of leave should be after first day of leave.

Last working day *

Day returning to work *

*Error!!! Last working day should be before first day of leave.

*Error!!! Day returning to work should be after last day of leave

Signature *

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Period of leave Date validation

Period of leave - Last working day validation

Day returning to work validation

Pay Cycle breakdown - Period of Leave

Pay Cycle breakdown Long Service Leave

Pay Cycle *

Leave days *

Public holidays *

Total hours *

Add another Pay Cycle

Pay Cycle *

Leave days *

Public holidays *

Total hours *

Add another Pay Cycle

Pay Cycle *

Leave days *

Public holidays *

Total hours *

Add another Pay Cycle

Pay Cycle *

Leave days *

Public holidays *

Total hours *

Add another Pay Cycle

Pay Cycle *

Leave days *

Public holidays *

Total hours *

Add another Pay Cycle

Pay Cycle *

Leave days *

Public holidays *

Total hours *

Total leave days

Total leave hours

Notes for Pay Cycle breakdown (if any)

Rostered Shift Hours of Duty

INSTRUCTIONS TO SHIFT WORKERS:

Please write total hours in the "Rostered Hours" field, NOT the shift start and end time.
If you are scheduled for an overnight shift, kindly split your hours worked into two days. For example, if your shift starts at 6:00 PM and ends at 6:00 AM the next day, please divide the shift into two separate shifts over two days. The breakdown would be 6:00 PM to 12:00 AM (6 hours) for the first day, and 12:00 AM to 6:00 AM (6 hours) for the second day.

Rostered Date *

Rostered Hours *

Are the rostered hours entered by the applicant correct as per the published roster? *

YesNo

Message to the approving supervisor regarding the amendments in the rostered hours (if any)A notification about the amendment and this message will be automatically sent to the approving manager.

Rostered Shift - Pay Cycle Breakdown

Pay Cycle *

Total hours *

Notes (if any)

Approving Supervisor to Complete

Approval *

ApprovedNot Approved

Not Approved Reason *

Relief arrangements required? *

YesNo

Who will relieve?

Supervisor Name *

Date *

Supervisor Signature *

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Type Signature

Comments (if any)

Do you need to notify others that this leave has been approved? *

YesNo

Send approval notification to *

*If there is more than 1 recipient, separate the email addresses by a comma ","

Would you like a copy of this form? *

YesNo

Once submitted a copy of this form will be sent to HR and the employee for reference.

*Error! Please fix the error/s above before submitting the form.

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