Employee Request for Leave of Absence Form

for Your State

This Employee Request for Leave of Absence form will effectively request a leave of absence from work. This request can easily be tailored to fit your unique needs.

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This Employee Request for Leave of Absence requests specific dates for a leave of absence. This request contains the name of the employee, date of the request and the specific days for which leave is requested. It also sets forth if the employer approves or denies this request. A written Employee Request for Leave of Absence will be helpful in the event there are questions or misunderstandings about an employee's absence from work.

This Employee Request for Leave of Absence contains:
  • Employee Information: Sets forth the name of the employee and the days which he or she requests for a leave of absence;
  • Employer Response: Gives the employer's approval or denial of this request.

Protect your rights by using our attorney-prepared forms.

This attorney-prepared packet contains:
  1. General Instructions
  2. Employee Request for Leave of Absence
State Law Compliance: This form complies with the laws of all states
Number of Pages2
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#29256
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.












Employee Request for Leave of
Absence Form









This Packet Includes:
1. Information
2. Employee Request for Leave of Absence Form





Information
Employee Request for Leave of Absence Form


This form may be used by an employee to request a leave of absence, if such leave is a benefit of their employment.  The employee should be given a copy of this form for their own records.  The original of the form should be placed in an employees personnel file.






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Employee Request for Leave of Absence Form

              
The undersigned employee, under the terms of his or her employment, requests the following
leave of absence dates: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature of Employee ______________________________   Date _______________________

Printed Name of Employee ___________________________



This Employee Request for Leave of Absence has been

   Approved

   Denied for the following reasons: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Signature of Employer _________________________________    Date ____________________

Printed Name of Employer ____________________________


Employee: Please keep a copy of this form for your records.

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