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Leave of Absence Form (New Zealand)

Leave of Absence Form (New Zealand)

Employment Relations Act 2000 — Holidays Act 2003

[Employer Name]

EMPLOYEE LEAVE APPLICATION FORM

Employment Relations Act 2000 — Holidays Act 2003

SECTION 1 — EMPLOYEE DETAILS

Employee Name: [Employee Name]

Job Title: [Employee Job Title]

Department / Team: [Employee Department]

Employee ID / Payroll Number: [Employee ID]

Employment Type: [Employment Type]

Region: [Employee Region]

SECTION 2 — TYPE OF LEAVE

Leave Type: [Leave Type]

Other Leave Description (if applicable): [Other Leave Type]

Sick Leave — Person Being Cared For: [Carer Relationship]

SECTION 3 — LEAVE DATES AND DURATION

Leave Start Date: [Leave Start Date]

Leave End Date: [Leave End Date]

Total Working Days Requested: [Total Days]

Expected Return-to-Work Date: [Return To Work Date]

Current Leave Balance: [Leave Balance]

SECTION 4 — REASON AND SUPPORTING DOCUMENTATION

Reason for Leave:

[Leave Reason]

Supporting Documentation / Medical Certificate: [Medical Certificate Attached]

Other Supporting Documentation: [Other Supporting Docs]

Work Cover Arrangements During Absence:

[Cover Arrangements]

SECTION 5 — STATUTORY LEAVE ENTITLEMENTS (SUMMARY)

The following statutory leave entitlements apply to this employee under the Holidays Act 2003 and the Parental Leave and Employment Protection Act 1987:

  • Annual Leave: 4 weeks (20 working days) per year after 12 months of continuous employment (s 16, Holidays Act 2003).
  • Sick Leave: 10 days per year after 6 months of continuous employment; may be carried over up to 20 days maximum (s 65, Holidays Act 2003).
  • Bereavement Leave: 3 days for close family members; 1 day for others where the employer accepts a bereavement has occurred (ss 69–70, Holidays Act 2003).
  • Family Violence Leave: 10 days per year from first day of employment; confidential and non-accumulating (ss 72A–72H, Holidays Act 2003).
  • Alternative Holiday: For each public holiday worked, an alternative holiday must be provided (s 56, Holidays Act 2003).
  • Parental Leave: Up to 26 weeks of primary carer leave (government-funded payments via Work and Income NZ where eligible) and up to 52 weeks total unpaid leave (Parental Leave and Employment Protection Act 1987).

The statutory entitlements listed above are minimums under New Zealand law and cannot be reduced by agreement.

SECTION 6 — EMPLOYEE DECLARATION

I declare that the information provided in this leave application is true and correct. I understand that providing false or misleading information in this form may result in disciplinary action under my employment agreement. I confirm that any supporting documentation attached to this form is genuine.

Employee Name: [Employee Name]

Signature: ____________________________

Date of Application: ____________________________

SECTION 7 — MANAGER APPROVAL

To be completed by the employee’s direct manager. Statutory leave entitlements (sick leave, bereavement leave, family violence leave, alternative holidays) cannot be unreasonably withheld.

Manager Name: [Manager Name]

Manager Title: [Manager Title]

Decision: [ ] Approved [ ] Approved with modification [ ] Declined (annual leave only)

Approved / Modified Dates (if different from requested): ____________________________

Reason for modification or decline (if applicable): ____________________________

Manager Signature: ____________________________

Date: ____________________________

SECTION 8 — HR / PEOPLE & CULTURE APPROVAL (WHERE REQUIRED)

Required for parental leave, extended leave without pay, and other complex leave types. Enter ‘N/A’ if HR approval is not required for this application.

HR / People & Culture Representative: [HR Rep Name]

HR Decision: [ ] Approved [ ] Approved with conditions [ ] Declined

HR Representative Signature: ____________________________

Date: ____________________________

Payroll notified: [ ] Yes [ ] No Date: ____________________________

Employee

________________

Signature

Approving Manager

________________

Signature

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What Is a Leave of Absence Form (New Zealand)?

A Leave of Absence Form for New Zealand is a standardised document used by employees to formally apply for leave from work, and by employers to record, process, and approve leave applications in compliance with the Holidays Act 2003 and the Employment Relations Act 2000. It serves as the official record of a leave request, the employee's declaration that the information is accurate, and the employer's decision on the application.

New Zealand's leave framework is established primarily by the Holidays Act 2003, which sets out the statutory minimum leave entitlements that every eligible employee is entitled to, regardless of what their employment agreement says. These entitlements include annual leave (4 weeks after 12 months of continuous employment under section 16), sick leave (10 days per year after 6 months of continuous employment under section 65), bereavement leave (3 days for close family members and 1 day for others under sections 69–70), public holidays with time-and-a-half pay and alternative holidays for working (sections 44–56), and family violence leave (10 days per year from the first day of employment under sections 72A–72H, inserted by the Domestic Violence — Victims' Protection Act 2018). Parental leave entitlements are governed separately by the Parental Leave and Employment Protection Act 1987.

A Leave of Absence Form is the administrative tool that connects the employee's statutory rights with the employer's operational requirements. By documenting each leave request, the form creates a record that the employer has received notice of the absence, that the correct type of leave has been applied for, and that appropriate approval has been given. This is important for payroll processing — confirming the employee receives the correct pay (or has unpaid leave recorded correctly) — and for compliance with the Holidays Act 2003's record-keeping requirements.

The form also serves an important practical purpose in managing the workplace during the employee's absence. By requiring employees to describe their work cover arrangements, the form confirms that clients, projects, and team responsibilities are not disrupted by unplanned absences. This supports the employer's duty of good faith under section 4 of the Employment Relations Act 2000 to maintain a productive employment relationship, which includes proactive communication about matters relevant to the employment relationship.

New Zealand's Leave of Absence Form differs from equivalents in Australia and the United Kingdom in several respects. Unlike Australia's Fair Work Act 2009, New Zealand has no Modern Award system — so leave entitlements are not supplemented by industry-specific awards. All leave entitlements flow from the Holidays Act 2003 and the employment agreement. New Zealand also provides more generous sick leave entitlements than Australia (10 days per year vs Australia's previous 10 days with a more complex accrual system), and provides the unique family violence leave entitlement from the first day of employment. The form must reflect the New Zealand legislative framework accurately to be compliant.

When Do You Need a Leave of Absence Form (New Zealand)?

A Leave of Absence Form is needed every time an employee in New Zealand applies for any type of leave from work — whether paid or unpaid, statutory or contractual. It is the essential administrative document that confirms leave is properly authorised, recorded, and processed in accordance with the Holidays Act 2003 and the employer's internal policies.

For annual leave, a Leave of Absence Form is needed to provide advance notice of the requested leave dates. The Holidays Act 2003 requires employees to give reasonable notice before taking annual leave, and employers need a formal record of the request to manage staffing levels and confirm business continuity. The form also allows the employer to confirm the employee's current leave balance and to approve or modify the dates based on operational requirements.

For sick leave, the form is needed when an employee is returning to work after an absence and the employer needs a formal record of the leave taken. In practice, many employers require employees to complete a leave form on return from sick leave, particularly for absences of more than one day, to support payroll processing and to document whether a medical certificate has been provided. Under section 68 of the Holidays Act 2003, employers may require medical evidence for sick leave of 3 or more consecutive calendar days, and the form is the appropriate place to record whether this evidence has been provided.

For bereavement leave, the form provides a formal record of the leave entitlement being exercised and the relationship of the deceased to the employee. This is important because the Holidays Act 2003 provides different entitlements (3 days or 1 day) depending on the closeness of the relationship. For bereavement leave of 1 day (for deaths where the employer accepts a bereavement has occurred), the employer's acceptance of the bereavement should be documented on the form.

For family violence leave, the form provides a confidential record that the leave has been applied for and approved. Importantly, the employee is not required to disclose the details of their situation — the form should record only that family violence leave has been applied for, without requiring supporting information that could breach the employee's privacy.

For parental leave, a Leave of Absence Form supplements the formal parental leave application (which is a separate letter under the Parental Leave and Employment Protection Act 1987). The form records the dates and duration of leave for payroll and HR records.

For leave without pay, the form is the key document recording that the employer has agreed to the unpaid absence and the terms under which the employee's position will be held open. The good faith obligation under the Employment Relations Act 2000 requires the employer to be transparent about any conditions attached to approved leave without pay.

Good record-keeping is not just an administrative established standards — it is a legal requirement. Under section 130 of the Employment Relations Act 2000, employers must keep wage and time records showing leave balances and leave taken. A properly completed Leave of Absence Form provides the evidence needed to satisfy these record-keeping obligations.

What to Include in Your Leave of Absence Form (New Zealand)

A properly completed Leave of Absence Form for New Zealand should include the following key elements to confirm compliance with the Holidays Act 2003 and the Employment Relations Act 2000.

Employee identification: The employee's full name, job title, department, employee ID or payroll number, employment type (full-time, part-time, fixed-term, or casual), and region of employment. This information allows the form to be linked to the employee's payroll and HR records, and confirms the correct leave entitlements are applied based on the employee's employment status.

Leave type: A clear identification of the type of leave being applied for, referencing the applicable provision of the Holidays Act 2003 or other legislation. The leave type determines the entitlement, any documentary requirements, and whether the leave is paid or unpaid. New Zealand employees have distinct leave entitlements — annual leave, sick leave (including carer's leave), bereavement leave, family violence leave, alternative holidays, parental leave, and leave without pay — and the correct category must be recorded for payroll and compliance purposes.

Leave dates and duration: The start date, end date, and total number of working days requested. For part-time employees, the total should reflect their usual working pattern. The expected return-to-work date is important for staffing and handover planning. Recording the employee's current leave balance is good practice and helps both parties confirm the employee has sufficient entitlement for the requested leave.

Reason and supporting documentation: The employee's reason for leave, and confirmation of whether supporting documentation (such as a medical certificate under section 68 of the Holidays Act 2003) is attached. For family violence leave, the reason field should respect the employee's privacy and confidentiality rights.

Work cover arrangements: A description of how the employee's work will be managed during their absence, supporting operational continuity and the employer's duty of good faith under the Employment Relations Act 2000.

Statutory entitlements summary: A reference to the relevant Holidays Act 2003 provisions clarifies both the employee's rights and the employer's obligations, and helps confirm the correct leave type is applied.

Employee declaration: A declaration by the employee that the information provided is true and correct, with a signature and date. This creates a formal record of the leave application.

Manager approval: A decision section for the approving manager, recording whether the leave is approved, approved with modification (for annual leave), or declined (for annual leave only — statutory entitlements generally cannot be declined). The manager's signature and date complete the formal record.

HR or payroll notification: A section confirming that the payroll team has been notified of the approved leave, confirming the employee receives the correct pay and the leave balance is updated accurately in the payroll system. The forms-legal.com Leave of Absence Form (New Zealand) provides a ready-to-use template that meets New Zealand legal requirements.

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Leave of Absence Form (New Zealand) (New Zealand) [Legal document template]. Forms Legal. https://forms-legal.com/new-zealand/employment/forms/leave-of-absence-form-new-zealand

MLA

"Leave of Absence Form (New Zealand) (New Zealand)." Forms Legal, 2026, https://forms-legal.com/new-zealand/employment/forms/leave-of-absence-form-new-zealand.

BibTeX
@misc{formslegal-leave-of-absence-form-new-zealand,
  author       = {{Forms Legal}},
  title        = {Leave of Absence Form (New Zealand) (New Zealand)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/new-zealand/employment/forms/leave-of-absence-form-new-zealand}},
  note         = {Free legal document template. Based on Employment Relations Act 2000}
}

Frequently Asked Questions

Based on Employment Relations Act 2000 — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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