Example of Request For Leave Template

Example Request For Leave Form

	Company Name
	Street Address
	City, State, Zip

 

Employee Name________________________________________________________________________

Position_______________________________________________________________________________

Requested Dates_______________________________________________________________________

Reason__________________________________________________________________________________

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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.

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Reason for request______________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

Employee Signature___________________________

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For Office Management Use ONLY

Approved______________
Denied________________	Reason_________________________________________________
Supervisor Signature_______________________ Date____________________

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