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How to write your own Employee Leave Request Form

You can create your own customized editable version of this contract document using Human Resources Contract Pack. Follow these steps to get started.


Use the Employee Leave Request Form to keep track of your employee time-off requests for various types of absence, such as family leave, sick time, vacation time, jury duty, military leave, etc. Use this form for accrual time management.
Document Length: 2 Pages
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1. Get Human Resources Contract Pack that includes this business contract document.

This Employee Leave Request Form is included in editable Word format that can be customized in Word or by using the included Wizard software.

2. Download and install after ordering.

Once you have ordered and downloaded your Human Resources Contract Pack you will have all the content you need to get started with your own formal declaration.

3. Customize the contract template with your own information.

You can customize the contract document as much as you need. You can also use the included Wizard software to automate merging in name/address data.

Employee Leave Request Form

How to write my Employee Leave Request Form document

Company Name

Employee: First Last Job title of signator, authorized signature or signer.

Contract Job Title Department: Department Supervisor: Supervisor Leave Date(s) Leave Start Date: Start Date Leave Return Date: End Date Total Number of Work Hours:

Instructions: Supervisor must complete the following form and file it with the Human Resources Department.

Reason for Leave

Leave Benefit(s) Used (Please check all that apply) Vacation Pay: ? Sick Pay: ? Personal Leave / Comp Time: ? Leave without Pay: ? Bereavement: ? Jury / Military Duty: ?

Maternity / Family Leave (FLMA Leave) : ? Other: ? Notes:

Leave Benefit Deductions * Hours verified by Human Resources.

Vacation Pay: hours

Sick Pay: hours

Compensatory Time: hours

Personal Days: hours

Leave without Pay: hours

Bereavement: hours

Jury / Military Duty: hours

Maternity Leave: hours

FLMA Leave: hours

Vacation Pay*: hours

Sick Pay*: hours

Compensatory Time*: hours

Personal Days*: hours

Leave without Pay*: hours

Bereavement*: hours

Jury / Military Duty*: hours

Maternity Leave*: hours

FLMA Leave*: hours

Employee and Supervisor are required to sign this Employee Leave Request in order to gain Company approval and to certify that all benefits requested by Employee are available. Upon approval by the Company, both Employee and Supervisor will receive written notification of said approval from the Company Human Resources Department. Please Note: Any accumulated Sick or Vacation Leave that the employee has accrued must be used prior to accepting Leave without Pay status.

Should the employee select Leave without Pay status, it is the sole responsibility of the employee to ensure that his or her Health and Medical coverage is continued. Employee should review the rights and responsibilities concerning Leave without Pay and the effect on Health and Medical Benefits prior to enacting Leave without Pay. Information concerning these rights and responsibilities may be found within the Company Human Resources Guide or by speaking with the Company Human Resources Department.

Employee Signature Date

Supervisor Signature Date

For Office Use Only

Approved By signator, authorized signature or signed

Human Resources Manager Date

Address Address City, State Postal Code

Phone Phone Number

The complete Employee Leave Request Form - with the actual formatting and layout - is available in this Contract Pack.
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Related documents may be used in conjunction with this document depending on your situation. Many related documents are intended for use as part of a contract management system.

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