Leave Application
Annual Leave and
Personal (Sick, Carers) Leave
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
Annual Leave
Further information is
available on the fact sheet
From
No. of hrs (if not full day)
To
No. of hrs (if not full day)
Total
hours/days
Please specify any dates not to be counted as leave (e.g. public holiday, flexi, RDO)
Annual Leave Lump Sum Payment (available in cases of hardship)
No. of working days to be paid
Preferred CSU pay date
Notes:
- A minimum balance of 20 working days must remain after a lump sum payment has been processed.
- Band 6 approval is required for an annual leave lump sum payment.
- In all cases, staff are encouraged to take leave rather than opting for a lump sum payment.
Personal Leave
Further information is
available on the fact sheet
From
No. of hrs (if not full day)
To
No. of hrs (if not full day)
Total
hours/days
If applying for carers leave, please specify which family member required care
A medical certificate/evidence is required for leave exceeding three (3) days.
The medical certificate should state the nature of the illness or incapacity and indicate the period of absence. Employees must not
return to work prior to the end date indicated on the medical certificate without first obtaining clearance from a medical practitioner.
Do you wish to take leave without pay if personal leave is exhausted?
Yes
(If taking sick leave without pay, please complete and application for sick leave without pay)
No
Signature and Authorisation
Employee
Supervisor
Name
Signature
Date
Submit to Supervisor
Name
Signature
Date
If Lump Sum Payment,
submit to Band 6 Delegate
Name
Signature
Date
Submit Approved Form to
the HR Service Centre
Band 6
Only required for
lump sum payments
Who is this?
HR Use Only
For lump sum payments:
For leave requests:
Fortnightly salary (FTE)
Timesheet entry processed (8ALCO)
Working day rate
Leave adjustment processed (FL604)
Number of working days to be paid
Amount to be paid (8ALCO)
Payment details sent to Payroll
Booking processed
Supporting document
Asset ID # 707594
Last Reviewed: April 2017