Employee Name:

Leave Commencement Date:
Leave Completion Date:
My Last Day At Work:
My First Day Back At Work:

Number Of Days

Public Holidays Included:

Type Of Leave

As part of my application for leave I acknowledge it is Mendi Constructions policy that as an employee of Mendi Constructions my Annual Leave is not permitted to accrue to more than 4 weeks. If I accrue more than 4 weeks leave a suitable time must be agreed between a Director of Mendi Constructions Pty Ltd. and me the employee.

Signature Of Employee
Signature Of Approver
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.