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Calvary Leave Form
Employee Name
Employee Number
Start Date (inclusive)
DD slash MM slash YYYY
Start Time
End Date (inclusive)
DD slash MM slash YYYY
End Time
Total Leave Days or Hours
Leave Type
(Required)
Annual
Study/TESL
Personal with Certificate
Personal without Certificate
Long Service Full Time Service
Long Service Part Time Service
Compassionate
Purchased
Maternity
Bonding
Leave Without Pay
Other
Rate of Pay
(Required)
Full Pay
Half Pay
Double Pay (LSL only)
Unpaid
Compassionate Leave Relation
Other Leave Details
Signature
Signature Date
DD slash MM slash YYYY
Send a Copy of Request Form to:
Calvary Anaesthetic Dept Email
Lee-Ann Harris Calvary Email
Graeme Gibson Calvary Email
Submitter's Email (will be CCed into Email)
(Required)
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Senders Email Email
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Calvary Email
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Lee-Ann
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Graeme
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