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Application for Sick/Bereavement Leave
Name:
Address:
Company of Assignment:
Date/s Taken:
I wish to apply for day/s sick leave*
*If you are absent for three or more consecutive days, Madison may require a
medical certificate before your sick leave will be approved.
I wish to apply for day/s bereavement leave
Madison have approved this bereavement leave request
Signature of Applicant:
Signature of Consultant:
Please return this to your consultant via email or post to:
Auckland PO Box 105 675, Auckland 1143
Auckland South East PO Box 259 253, Botany 2163
Waikato PO Box 19382, Hamilton 3244
Wellington PO Box 3357, Wellington 6140
Christchurch PO Box 2044, Christchurch 8140