Leave Request Form

Fields marked with * are required.

Depot/Region *

Employee Name *

Type of Leave *

—Please choose an option—Annual LeaveBereavement LeaveCarers Leave** Sick LeaveTime off in LieuOther

** Medical Certificate attached?

—Please choose an option—NoYes

Upload Medical Certificate if applicable

Leave Requested *

—Please choose an option—PaidUnpaid

Payment Method *

—Please choose an option—In AdvancePay week by week

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.

Please leave this field empty.

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