To be completed only by Emergent Temporary Worker A separate form to be completed for each leave period and type.
Alternatively, leave can also be applied for via the Emergent time sheet system.
*Sick LeaveAnnual LeaveBereavement LeaveOther Leave
If "Other" provide more detail in 'Additional message details' below.
*I wish to apply for (enter number) days of leave
[If more than three consecutive sick leave days, Emergent may require a medical certificate]
My first day (date) of leave:
Returning to work on
I have provided a medical certificate or other supporting information: AttachedProvided separatelyNot required
Attach any medical certificate or supporting information here: [PDF, JPG, or GIF formats only]
Additional message details
Confirmation of my identity:
Date of Birth* Company and location of assignment I am/was engaged*:
Are you human or machine? Please type the text below (not case sensitive)*
The above is for Emergent temporary workers on assignment. Contact us for more information.