Staff Leave Request FormPlease enable JavaScript in your browser to complete this form.Fields marked with an * are required. Employee Name *Employee Email *Manager Name *Cath LaniganKarin PennyManager Email *business.manager@drss.vic.edu.aukarin.penny@drss.vic.edu.au___________________________________________________________________________________________________________________________________________________ Type of Leave *Annual LeaveSick / Carer's LeaveLeave without PayOtherOther field will be displayed according to the value selected in this sectionPlease Specify *Sick / Carers LeaveLayoutEnter DateStart Time Finish TimeOr Date RangeLayoutFirst Day of LeaveLast Day of LeaveHours Usually Worked that dayHours Taken as Sick LeaveFile UploadPlease upload your Medical CertificateRemarksAdditional Row 1Add New RowLayoutEnter DateStart TimeFinish TimeOr Date RangeLayout First Day of Leave Last Day of LeaveHours Usually Worked that dayHours Taken as Sick LeaveFile UploadPlease upload your Medical CertificateRemarksAdditional Row 2Add New RowLayout Enter DateStart TimeFinish TimeOr Date RangeLayout First Day of LeaveLast Day of Leave Hours Usually Worked that day Hours Taken as Sick LeaveFile Upload Please upload your Medical CertificateRemarksAdditional Row 3Add New RowLayout Enter Date Start TimeFinish TimeOr Date RangeLayoutFirst Day of Leave Last Day of Leave Hours Usually Worked that dayHours Taken as Sick LeaveFile UploadPlease upload your Medical CertificateRemarksAdditional Row 4Add New RowLayout Enter DateStart Time Finish Time Or Date RangeLayoutFirst Day of LeaveLast Day of LeaveHours Usually Worked that dayHours Taken as Sick LeaveFile UploadPlease upload your Medical CertificateRemarksAdditional Row 5Add New RowLayout Enter DateStart TimeFinish TimeOr Date RangeLayoutFirst Day of LeaveLast Day of Leave Hours Usually Worked that day Hours Taken as Sick LeaveFile UploadPlease upload your Medical CertificateRemarksAnnual LeaveFirst Day of Leave *Last Day of Leave *Total Leave Days TakenTotal Leave Hours Taken CRT or Name of Replacement StaffFirstLastRemarks___________________________________________________________________________________________________________________________________________________ Employee Signature *Clear SignatureDate *CommentSubmit
