N A M E Please return completed form to payroll, head office. Employee Name: Position: State: L E A V E R E Q U E S T TYPE NUMBER OF DAYS Annual Leave Public Holidays Rostered Day Off (R.D.O.) Long Service Leave Other (Please specify) TOTAL Leave to be taken from: (First day of leave - dd/mm/yy) To: (Last day of leave - dd/mm/yy) Date of return to work: (dd/mm/yy) AMENDED APPLICATION? NOTE: Any changes to number of days or dates for this application must be submitted on a new form with the word "Amended" clearly marked. Click above if you are submitting an amended application.. A U T H O R I S E D Employee: Date: (dd/mm/yy) Authorised by: Title: Date: (dd/mm/yy)