Carer’s Leave

This form is to be used by employees to apply for Carer’s Leave.

The applicant must:

  • Have completed 12 months employment.
  • Have made an application to the Department of Social and Family affairs for a decision that the person to be cared for is in need of continuous supervision and care throughout the day.
  • Give written notice no later than 6 weeks before the intended commencement date.

To be completed by the Employee

Carers leave Form - To be completed by the Employee

"*" indicates required fields

Section 1

Full Name*

Section 2

Section 3

Please give details of the duration of the proposed Carer's Leave:
DD slash MM slash YYYY
DD slash MM slash YYYY

Section 4

DD slash MM slash YYYY

Section 5

DD slash MM slash YYYY

To be completed by the Line Manager

Carers Leave Form - To be completed by the Line Manager

"*" indicates required fields

Section 1

I have checked the relevant supporting documentation required for the leave requested and confirm that leave approved complies with the terms outlined in the relevant HR Policy.
Copy of application to the Department of Social and Family affairs for a decision that the person to be cared for is in need of continuous supervision and care throughout the day
Copy of Decision from the Department of Social and Family affairs
MM slash DD slash YYYY
I confirm the named employee has completed 12 months employment:

Section 2 - Confirmation Agreement

DD slash MM slash YYYY
DD slash MM slash YYYY

Effective Period of Carer's Leave

DD slash MM slash YYYY
DD slash MM slash YYYY

To be completed by Employee

DD slash MM slash YYYY
Name*

To be completed by Line Manager

DD slash MM slash YYYY
Name

Confirmation Document

Purpose:
This document is to confirm that both the Line Manager and Employee are agreeable to the taking of Parental Leave over the course of the From and To dates and to the way in which it will be taken, as stated below.

This document must be completed no later than 4 weeks before the leave is due to begin. Once this document has been signed by both parties, it cannot be altered unless both parties agree. The applicant must be given a copy of this confirmation document.

Carers Leave Form - Confirmation Document

"*" indicates required fields

Section 1 - To be completed by the Employee

*
DD slash MM slash YYYY
Name*