Employee leave form
Office Use Only
Employee Number:
Surname:
Given Names:
School/Section
Location:
Ext.
* Annual Leave and Sick Leave must be recorded as hours. (NB: 7.35 hours constitutes one full day for all
General/Professional Staff, 7.6 hours constitutes one full day for Academic and TAFE Teachers at Ballarat and Western
Campuses, and 7.25 hours constitutes one full day for Academic staff at Gippsland.)
Leave
Code
Leave Type
1.
Annual Leave*
2.
Sick Leave* [Personal Injury/Illness]
Leave
Code
No. of
days/hours
taken*
Inclusive Period
(dd/mm/yy)
From
To
(attach Doctor’s Certificate if over 3
consecutive days.)
3.
Long Service Leave (TAFE Teacher’s
LSL application process continues to apply.)
4.
Paid Maternity Leave (attach Doctor’s
Certificate and letter of request.)
5.
Unpaid Maternity Leave (attach
Doctor’s Certificate and letter of request.)
6.
Paternity/Partner Leave (attach
Doctor’s Certificate or Statutory Declaration.)
7.
Leave Without Pay (attach letter of
request indicating reason required.)
8.
9.
Bereavement/Compassionate
Leave (must indicate family relationship to
employee in “Details” section.)
Details
WorkCover (return this form directly to the
(must be completed for Carer’s and Additional Leave,
Bereavement/Compassionate Leave)
Return to Work Co-ordinator, Human
Resources.)
10.
Carer’s Leave (attach Doctor’s Certificate
if over 3 days. Indicate family relationship to
employee in “Details” section.)
11.
University Business/Conference/
Travel Leave
12.
Other Type of Additional Leave
(please specify in “Details” section eg. Court
Attendance. NOTE: some form of evidence
may be required.)
Staff member’s signature:
Supervisor’s name:
Supervisor’s signature:
For further information about leave options, please refer to
the leave provisions in your relevant enterprise agreement.
Date:
Approved
Not approved
Date:
Page 1 of 1
CRICOS Provider No. 00103D
Warning: uncontrolled when printed.
Authorised by:
Director, Human Resources
Document owner:
Manager, Payroll and Systems
Original Issue:
Current Version:
01/01/2008
15/01/2014