Application for Leave s1

Application for Leave

Instructions

1.Use this form for all types of leave except Long Service Leave and Leave Without Pay | 2.This form must be signed by the applicant and the delegate | 3.Guidance - Refer to fact sheet ‘Leave Application Forms – Supplementary Information' | 4.Conditions - Refer to Directorate Enterprise Agreement and/or Directorate policy/guidelines

Draft Version 3.1 Issued: 04/06/2007 Page 2 of 1

Applicant to Complete
Family name: / Given names: / Permanent/TemporaryPermanentTemporary
Choose Organisation:Chief Minister and TreasuryCITCommerce and WorksCommunity ServicesEconomic DevelopmentEducation and TrainingEnvironment and Sustainable DevelopmentHealthJustice and Community SafetyTerritory and Municipal Services / Classification: / AGS/Employee Number:
Are you currently salary packaging? Yes/NoYesNo / Tel (work): / Tel (on leave):
Leave Type (Refer to fact sheet ‘Leave Application Forms – Supplementary Information for guidance on ‘Other’.)
Annual / Leave Loading / Prepayment
Personal Evidence Attached/Without EvidenceEvidence AttachedWithout Evidence / Personal in Special Circumstances Reason:
Other (specify) / Documentation attached
Purchased Note: A Directorate Purchased Leave Scheme form provides general approval to access the scheme and must have been completed and approved prior to submitting this application.
Maternity/Primary Care Giver Certificate/other documentation attached
Period and Payment
Full pay From: : am/pmampm on // To: : am/pmampm on //
Total days requested: OR Total hours requested:
Half pay From: : am/pmampm on // To: : am/pmampm on //
Total days requested: OR Total hours requested:
Maternity/Primary Care Giver Without Pay
From: : am/pmampm on // To: : am/pmampm on //
Signature: Date: : //
Manager/Supervisor to Complete
Supported / Not supported, reason:
Name: / Position Title: / Tel:
Signature: Date: //
Delegate to Complete
Approved / Not approved, reason:
Name: / Position Title: / Tel:
Signature: Date: //
Shared Services to Complete
Email to Salary Packaging advising of reduced pay and leave dates Yes N/A / Salary Adjustment Date:
Prepared by: / Signature: / Date:
Checked by: / Signature: / Date:

Send to Shared Services for action via:

Shared Services Customer Service Portal after saving the document to a preferred drive and attaching to an enquiry |

Email to | Internal mail to Shared Services, Level 5, Eclipse House, 197 London Cct Canberra City

Draft Version 3.1 Issued: 04/06/2007 Page 2 of 1