Leave Request Form
How to submit a leave request
1. Fill out the leave request form with accurate details.
2. Submit the form to your direct manager for approval, with HR copied (CC) on the email.
3. Once approved, HR will verify and process the request.
4. HR will provide a copy of the approved request for your records.
Employee details
Employee name Department
Manager/Supervisor
Job title
name
Leave request details
Leave request [Number] Days Hours
Starting on [MM/DD/YYYY] Ending on [MM/DD/YYYY]
Reason for leave request
Vacation Family Reasons Jury Duty
Personal Leave Medical Leave To Vote
Parental Leave Funeral/Bereavement Other:
I confirm that the information provided in this leave request form is accurate and complete.
I understand that this request is subject to approval by my employer.
Employee signature
Date [MM/DD/YYYY]
Notes and comments (Optional)
Employer’s decision
Approved Rejected
Employer representative signature
Date [MM/DD/YYYY]
Notes and comments (Optional)