"Leave of Absence Form"

A Leave of Absence Form is a formal statement filled out by an employee who needs to spend time away from work due to special circumstances - annual leave, sickness, compensatory time off accumulated after working overtime. Whether you are dealing with a medical emergency, preparing to give birth to a child, or simply asking the employer to schedule several paid weeks off work you are entitled to in accordance with your employment agreement, use this document to inform the company about the upcoming absence.

Alternate Name:

  • Leave of Absence Request Form.

Download a Leave of Absence Form template via the link below. To make sure your employer grants you time away from work without any issues, you need to indicate your name, social security number, and department, state the date you submit the request and the name of the company, explain why you need to be permitted to be away from the workplace and enter the dates of proposed leave, check the type of leave you are requesting, and add necessary comments. Your supervisor or a human resources department representative will approve or disapprove the request and sign the document once they review your statement.


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Leave of Absence Form
____________________
____________________
____________________
Employee Name
Date
SSN
________________________________________________________________________
Organization
________________________________________________________________________
Department
Purpose for Leave: ________________________________________________________
________________________________________________________________________
________________________________________________________________________
Dates of Leave: ___________________________________________________________
Type of Leave (check one):
❏ Annual Leave
❏ Unpaid Absence
❏ Sick Leave
❏ Other: _____________________
❏ Compensatory Time Off
___________________________
Additional Remarks: ______________________________________________________
________________________________________________________________________
________________________________________________________________________
Supervisor’s Decision
❏ Approved
❏ Disapproved
Reason for Disapproval: ___________________________________________________
________________________________________________________________________
________________________________________________________________________
____________________________
____________________________
Supervisor’s Signature
Date
©
TEMPLATEROLLER.COM
Leave of Absence Form
____________________
____________________
____________________
Employee Name
Date
SSN
________________________________________________________________________
Organization
________________________________________________________________________
Department
Purpose for Leave: ________________________________________________________
________________________________________________________________________
________________________________________________________________________
Dates of Leave: ___________________________________________________________
Type of Leave (check one):
❏ Annual Leave
❏ Unpaid Absence
❏ Sick Leave
❏ Other: _____________________
❏ Compensatory Time Off
___________________________
Additional Remarks: ______________________________________________________
________________________________________________________________________
________________________________________________________________________
Supervisor’s Decision
❏ Approved
❏ Disapproved
Reason for Disapproval: ___________________________________________________
________________________________________________________________________
________________________________________________________________________
____________________________
____________________________
Supervisor’s Signature
Date
©
TEMPLATEROLLER.COM