PURCHASED LEAVE
APPLICATION FORM /

This form is to be used by staff to apply for Purchased Leave in accordance with the relevant procedure.

STAFF MEMBER DETAILS

Full Name: / Employee Number:
Position Title:
Employment Type: / Full time Part Time – current work hours per week/service fraction:
Organisational Unit:

ELIGIBILITY REQUIREMENTS

I confirm that:

I hold a continuing appointment or have at least 12 months left on my current contract of employment
I do not have an excess Recreation Leave or Long Service Leave balance, in accordance with the The University of Queensland Enterprise Agreement 2014-2017
I do not have an excess Flexitime or VBT balance (HEW 1 -7), in accordance with the Hours of Work, Overtime & Staff Attendance (Professional Staff) Procedures

PURCHASED LEAVE OPTIONS

I would like to purchase the following number of week(s) leave: 1 week 2 weeks 3 weeks 4 weeks

This arrangement will commence in the next practicable pay period once approved. A future commencement date may be nominated below however, where the date falls mid pay period, the arrangement will commence at the start of the next pay period.

Nominated Commencement date : (optional)

ALLOWANCES AND SALARY LOADINGS (IF APPLICABLE)

I am in receipt of an allowance and/or salary loading, which is expected to span the duration of the purchased leave arrangement, and that I request be included in the calculation of the purchased leave deductions and subsequent payment(s).

Please provide details below:

PROPOSED DATES OF LEAVE TO BE TAKEN

A staff member on a purchased leave arrangement must use the amount of leave purchased and their annual recreation leave accrual during the 26 fortnightly pay periods. This Recreation Leave and the Purchased leave will be entered by the relevant Human Resources staff. If additional space is required, please attach the proposed leave plan as a separate document.

Purchased Leave will be taken on the following dates (minimum 1 week blocks):

Date from (inclusive): / Date to (inclusive): / Number of Working Days:
TOTAL:

Recreation Leave accrued during the arrangement will be taken on the following dates:

Date from (inclusive): / Date to (inclusive): / Number of Working Days:
TOTAL:

Request for Flexible Working Arrangements - Fair Work Act 2009 (Cth) (optional)

Certain staff members have the ‘right to request’ a flexible work arrangement in accordance with the Fair Work Act 2009 (Cth) in the following circumstances:

o  The staff member is a parent or has responsibility for the care of a child who is of school age or younger
o  The staff member is a carer in accordance with the Carer Recognition Act 2010 (Cth)
o  The staff member has a disability
o  The staff member is 55 years of age or older
o  The staff member is experiencing violence from a family member
o  The staff member is providing care or support to a member of their immediate family or a member of their household who is experiencing violence from their family
This request is being made in accordance with the ‘right to request’ provisions in the Fair Work Act 2009 (Cth) Yes No
I confirm that I have completed at least 12 months of continuous service with the University prior to making this request Yes No

A staff member who is requesting a flexible work arrangement under the provisions of the Fair Work Act 2009 (Cth) may be required to provide reasonable evidence to support their application to the Authorised Officer.

REASON FOR SEEKING PURCHASED LEAVE

Please outline the reason(s) purchased leave is being sought below:

STAFF MEMBER DECLARATION

I acknowledge that:

·  I am required to take both Purchased Leave and Recreation Leave accrued during the 26 fortnightly pay periods of the Purchased Leave arrangement

·  I will receive a fortnightly pre-tax salary deduction calculated in accordance with the Purchased Leave Procedure

·  My employer and personal superannuation contribution arrangements will continue during periods of Purchased Leave

·  At the conclusion or cessation of a Purchased Leave arrangement, the Purchased Leave taken and deductions made will be reconciled, and any monies owing to the University must be repaid as soon as reasonably practicable in accordance with the relevant legislation

·  I have read and understood the conditions of the arrangement as outlined in the Purchased Leave Procedure

Signature / Date
Staff member:
The request for Purchased Leave is: Supported Not supported
Consideration:
Name:
Position:
Signature: / Date:

AUTHORISED OFFICER TO COMPLETE

Where a request is submitted in accordance with Section 65, Division 4 of the Fair Work Act 2009 (Cth), the University is required to provide a written response within 21 days of receipt of the request. The University may only refuse a request made in accordance with Section 65, Division 4 of the Fair Work Act 2009 (Cth) on reasonable business grounds. In the instance a request made under this section of the Fair Work Act 2009 (Cth) is not approved, the Authorised Officer must consult with Human Resources prior to informing the staff member of the decision.

Purchased Leave is: Approved Not approved
Consideration:
Name:
Position:
Signature: / Date:

HUMAN RESOURCES STAFF TO COMPLETE

Calculations
Number of weeks purchased: / Pay period Purchased Leave arrangement to commence:
Value of week/s purchased, including base salary and allowance(s)/loading(s) as applicable: / Date Purchased Leave arrangement will cease:
Fortnightly deduction amount to be set up:
Purchased Leave and Recreation Leave occurrences entered into Aurion
Copy of the Purchased Leave Application Form included in the staff members file
Copy of the Purchased Leave Application Form provided to the staff member upon approval
If Purchased Leave application request is made in accordance with Section 65, Division 4 of the Fair Work Act 2009 (Cth), written response provided to staff member within 21 days of receipt of the request
As applicable, allowance(s)/loading(s) approved for inclusion in Purchased Leave calculation have been included.
Purchased Leave Deduction set up in Aurion
Name / Date
Details Entered by:
Details Checked by:

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