Anonymous

USI Worker Leave Form - Updated March 2018

To be completed by installers and office staff prior to taking time off

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Title Page

USI Worker Leave Form - Please Seek Managers Approval Before Submitting Form

1. Full Name
- Benjamin Elliot
- Cameron Worthington
- Heneli Vaiika
- Jack Redman
- Jacob Upton
- James Flynn
- James Hollingsworth
- Jayden Sutinen
- Jethro Papkovics
- Joshua Marion
- Mark Sheridan
- Michael Zinghini
- Benjamin McCullan
- Lee Swale
- Lima Shinwari
- Nathan Laviano
- Noora Bayrouti
- Phil Blackman
- Rhoda De Leon
- Steven Balbi
- Steven Chamaty
- Peter Harris
2. Type of Leave
- Annual Leave
- Unpaid Leave
- Left Early Unpaid
- Left Early Paid
- Compassionate Leave
- Half Day RDO
- Half Day RDO & Half Day Annual Leave
- Sick & Carers Leave (Medical Certificate must be provided to HR)
3. First Day of Leave (if leaving early go to Q4)
Last Day of Leave (if applicable)
Return to Work Date (if applicable)
How many days Annual Leave will you be taking ?
4. Hours Left Early (if applicable)
Employee Signature
Approved by Peter Harris

Anonymous

USI Worker Leave Form - Updated March 2018

To be completed by installers and office staff prior to taking time off

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.