Leave Application
Long Service Leave
If requesting a period of leave, this can be booked through Web Kiosk if you are a full time staff member, or a part time staff
member with a roster.
A leave request should only be submitted using this form if you are a part time staff member without a roster.
Employee Details
Employee Number
Campus
Name
Faculty/Division/Office
Fraction
School/Section/Centre
Part Time Staff Must Complete
Please specify roster for the fortnight commencing the Friday immediately after pay day.
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Hours
Leave Details (Further information is available on the fact sheet)
Long Service Leave
From
No. of hrs (if not full day)
To
No. of hrs (if not full day)
Total number
of days
Notes:
- The minimum period of long service leave to be taken is five (5) working days.
Lump Sum Payment (available in cases of hardship)
No. of days to be paid
Preferred pay date
Notes:
- An employee must have a long service leave entitlement of one (1) month or more to elect to be paid in the form
of a lump sum payment for part or all of their long service leave entitlement.
- Payment shall not be made for a period of less than one (1) month of long service leave.
- In all cases, staff are encouraged to take leave rather than opting for a lump sum payment.
Signature and Authorisation
Employee
Supervisor
Band 6
Who is this?
Name
Name
Name
Signature
Signature
Signature
Date
Date
Date
Submit to Supervisor
Submit to Band 6
Delegate for Approval
Submit Approved Form to
the HR Service Centre
HR Use Only
For lump sum payments:
For leave requests:
Fortnightly salary (FTE)
Timesheet entry processed (8LLSL)
Daily rate
Leave adjustment processed (FL604)
Number of days to be paid
Amount to be paid (8LLSL)
Last Reviewed: April 2017
LSL booking processed
Payment details sent to Payroll
Asset ID # 149725