Leave Request Form
Employee Name
*
First Name
Last Name
Employee Email
*
example@example.com
Employee Phone Number
*
-
Area Code
Phone Number
Manager's Email
*
example@example.com
Full-Time Leave Request (please reference HR handbook for usage rules)
*
Upload doctor's notes, jury duty notice or other needed documentation for leave approval.
Browse Files
Cancel
of
Configurable list
Additional Comments or Explanation:
Employee Signature
*
Clear
Supervisor Approval
Action
Approved
Denied
Additional Comments
Supervisor Signature
Clear
Submit Form
Submit
Print Form
For HR Use Only
Date Updated in Time Clock
/
Month
/
Day
Year
Date
Submit
Print Form
Should be Empty: