ACS-F201 Leave Application Form

ACS-F201 Leave Application Form
Date*

DayMonthYear
Date
Employee *

First NameLast Name
Email*
Please use Britex/acsi email address
Manager *
Please ensure you select your direct manager
State / Territory
Please select your state/territory from dropdown
Choose leave type from dropdown menu below*
Medical certificate to be attached below if on personal leave for more than 1 day
Medical certificate/other documents to be added

Cancelof
Other (advise reason)
First day of leave*

DayMonthYear
Date
Last day of leave(not date return to work)*

DayMonthYear
Date
Total number of working days absent*
Do not include weekends or public holidays
Arrangements made for leave period. Who will assist while you are away with your specified jobs/tasks daily. Please ensure this person is made aware.*
Employee Signature
Manager Signature

Clear
Please sign above & click on Submit below.

This form will be sent to payroll@acsi.com.au & your manager for approval.
Should be Empty: