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EmployeeLeaveRequestForm PDF

This employee leave request form allows employees to request time off from work for various reasons including vacation, sick leave for themselves or family members, jury or military duty, doctor's appointments, worker's compensation, family medical leave, bereavement leave, or other reasons. The employee fills out their name, department, supervisor, dates and times of the requested leave, and reason for the leave request. The supervisor then reviews the request, provides any comments, and indicates whether the request is approved by signing and dating the form.

Uploaded by

Keeshen Rivera
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We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
969 views1 page

EmployeeLeaveRequestForm PDF

This employee leave request form allows employees to request time off from work for various reasons including vacation, sick leave for themselves or family members, jury or military duty, doctor's appointments, worker's compensation, family medical leave, bereavement leave, or other reasons. The employee fills out their name, department, supervisor, dates and times of the requested leave, and reason for the leave request. The supervisor then reviews the request, provides any comments, and indicates whether the request is approved by signing and dating the form.

Uploaded by

Keeshen Rivera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Employee Leave Request Form

Employee Name Date


Department Supervisor Name

REASON FOR LEAVE

Vacation Civil Leave /Jury Duty Military

Sick - Self Sick - Family Sick – Dr. Appointment

Worker’s Comp Family and Medical For

Leave of Absence Funeral – Relationship:

Other

LEAVE REQUESTED

From Time a.m/p.m Total Number of Hours Requested


To Time a.m/p.m Total Number of Days Requested
Other

Employee Signature Date

SUPERVISOR USE ONLY

Comments:

Approved By:

Supervisor Signature Date

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