Please return to: VL158 Updated 07/11 Payroll – Team 05 Shared Services SA Courier R11/15 or DX 703 Payroll Group GPO Box 11026 Adelaide 5001 Ph: (08) 8462 1305 (Press 1) Group Fax: (08) 8124 9605
APPLICATION FOR LONG SERVICE LEAVE
SECTION 1: EMPLOYEE DETAILS
PERSON Family Given ID Name Name(s) Location Location Number
Classification Job Title (e.g. SSO1)
Please attach address details for communications whilst on leave if different to current residential address records held by State Office
SECTION 2: LEAVE DETAILS (All Employees to Complete)
Patterned Long Service Leave Period of Leave From To Inclusive (Attach a full list of the dates for patterned LSL)
Days at half pay Total calendar days To comprise Days at full pay and / or
Is this application for Long Service Leave in lieu of Sick Leave? *NOTE: Not available at half pay. Medical certificate must be attached. Yes
PAYMENT OPTIONS: If long service leave is granted, I request to receive: (please mark with an x) (See reverse for details on options available)
Standard fortnightly Advanced payment split over two financial Payment in advance OR OR payments years
EMPLOYEES WHOSE SERVICE INCLUDES PART-TIME SERVICE: Payment Entitlements: (See reverse for details on options available)
Nominated Percentage of Full Time Average Rate Full Time Rate OR OR % Rate I hereby authorise all salary adjustments that may result from this leave application. I understand also, that I must obtain written approval before undertaking any employment whilst on this leave and that failure to do so may result in formal disciplinary action. Applicant's signature: Date / /
SECTION 3: RECOMMENDATION - SUPERVISING OFFICER
Please Print Signature Name
Position Date / /
SECTION 4: DELEGATE APPROVAL: Subject to entitlement
Please Print Signature Name
Position Date / /
SECTION 5: OFFICE USE
Entitlement available? If No, Applicant / Delegate notified on Date / / YES NO
Entered by (Initials) Signature: Date / /
Checked by (Initials) Signature: Date / / Please turn over for details
NOTES FOR GUIDANCE IN USE OF THIS FORM
This form is for use by all DECD employees applying for long service leave.
It is the responsibility of applicants to know the details of their long service leave entitlements. Information on long service leave entitlements is available on the departmental web sites, including the appropriate Acts and Commissioner’s Determinations. Long Service Leave entitlements are noted in the ‘Leave Entitlements’ section on
your Earnings Advice. For further information contact Shared Services SA Payroll via email on Payroll05@sharedservices.sa.gov.au. Note that if the details contained within any application for long service leave fail to fit within the applicant’s long service leave entitlements, the application will not be processed and may be returned to the site.
Patterned Long Service Leave
Patterned Long Service Leave is where you elect to use single day/s of LSL on a periodical basis e.g. every Tuesday for a period of six weeks. Applications for patterned long service leave require this form to be submitted in conjunction with a listing of all the individual dates you wish to have leave.
Tick the box marked Patterned LSL and insert the first day of absence and the last day of Patterned LSL absence. Attach a complete list of each day absent during the period of this application.
Long Service Leave in Lieu of Sick Leave
Long service leave in lieu of exhausted paid leave may be granted for periods of less than seven calendar days, provided that successive periods of long service leave for such purposes are not broken by non-working days. Such leave cannot be taken at half pay. An appropriate medical certificate must be provided for all applications of long service leave in lieu of sick leave.
PAYMENT OPTIONS – All Employees
; Standard Fortnightly Payments
Applicants selecting this option elect to be paid the salary to which they are entitled during such Long Service
Leave in normal fortnightly payments.
; Payment in Advance
Applicants selecting this option elect to be paid at the commencement of such Long Service Leave, the total
salary which would be payable on the paydays falling during the currency of said leave. (NB: Where the period
of the leave spans two financial years, this choice could result in a higher incidence of income tax for the year
in which the leave commenced. For further details contact Shared Services SA Payroll.)
; Advanced Payment Split Over Two Financial Years
Applicants may elect this option in such cases where the leave spans a financial year and selecting the
Payment In Advance option will incur a higher incidence of income tax. This option allows for payment to be
spread over each of the financial years involved, in proportion to the amount of leave applicable. The incidence
of taxation is therefore similar to that for an election under the first option.
When selecting this option, payment will be calculated and received in two amounts. The first payment due will
be made on the payday immediately prior to the commencement of said leave and include salary up to the last
pay day in the financial year. The second payment due will be made on the first payday falling in July and
include salary up to the last pay day during the leave.
ENTITLEMENT OPTIONS – Part-Time Employees
; Average Rate
The average rate is based on accrued hours (Non School Sector Teachers) or fortnights (School Sector
Teachers) per calendar day of leave which considers all changes in fraction of time during employment. ; Full-Time Rate
Payment will be based on a full-time rate of pay. The entitlement reduction is based on the number of calendar
days and hours/fortnights used. This option will result in a reduction to the average rate calculated in future. ; Nominated Percentage of Full Time Rate
Payment will be based upon a nominated percentage of time per week as specified by the applicant. This
option may also result in a reduction to the average rate calculated in future.
WORKING WHILE ON APPROVED LONG SERVICE LEAVE
Employees taking Long Service Leave should note that undertaking other employment while on Long Service Leave without formal DECD approval may make them liable to disciplinary action.