Leave Application Form
Leave Application Form
Employee’s details
Name
Position
Contact Number
Leave Type
NOTE: Leave requests will need to be submitted for approval, at least 2 weeks prior
Leave (full Day) Sick Leave (With Medical Certificate)
Leave (half Day) Sick Leave (Without Medical Certificate)
Leave without Pay OTHER
Employee Comments
NOTE: OTHER Leave Request must have additional commentaries – i.e. leave in lieu, grievances, etc.
Employee Acknowledgement
I have submitted my leave at least 2 weeks prior Yes
Upon termination of employment, I understand any leave Yes, I understand
taken that has not been accrued can be withheld from
my wages.
I have checked with my Manager/supervisor for a Yes
verbal approval and will get them to sign off this
form
Period of Leave
NOTE: Do not include public holidays or substituted days in the total
Start Date
Return to work date
Total of number of working days off
Signature of employee: Date: / /
Human Resource
Process
Leave Application Form
Approval of leave
To be completed by Manager/Supervisor
NOTE: Managers/Supervisors are responsible for notifying HR of Leave Requests, which can be
added into Teams for digital record
Approved Not approved
Reason for refusal (if applicable):
Name of manager/supervisor:
Signature of manager/supervisor: Date: / /
Human Resource
Process