Leave Request Form

    Fields marked with * are required.

    Depot/Region *

    Employee Name *

    Type of Leave *

    ** Medical Certificate attached?

    Upload Medical Certificate if applicable

    Leave Requested *

    Payment Method *

    Leave Period

    First day of Leave *

    Last day of Leave (inclusive) *

    Total number of Days *

    Total number of Hours *

    By checking this box, I hereby declare and warrant that I have read and completed the leave request form and that the answers above are in every respect true and correct and that I have not with-held any material information. I also understand that this form is a leave request only and that any leave is not approved or rejected until Management review and process and leave request form officially and provide a written response to you.