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Example of Request For Leave Template

Example Request For Leave Form

  Company Name
  Street Address
  City, State, Zip


Employee Name________________________________________________________________________
Requested Dates_______________________________________________________________________


                   I hereby submit this form to officially request ______________________ hours/days of leave.
This time off is to begin___________________and end_____________________.

I understand that this is only a request and must be approved by a supervisor. If I exceed my requested
time off, the extra time will be automatic unpaid time off, even if paid days are available unless I contact
my supervisor prior to the missed days.


   Reason for request______________________________________________________________________

Employee Signature___________________________

For Office Management Use ONLY

Denied________________ Reason_________________________________________________
Supervisor Signature_______________________ Date____________________

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Download Excel Version of Example Request For Leave example
Download Example Request For Leave Excel Template