Unpaid Leave Request Form
Please complete this form if you would like to request unpaid leave. Please note unpaid leave is for exceptional circumstances only.
Requester Name
*
First Name
Last Name
Requester Email
*
example@example.com
Line Manager Name
*
First Name
Last Name
Line Manager Email
*
example@example.com
Head of Department
*
Please Select
Ed Davis
Kevin White
Chris Topley
Carly Spencer
Mike Dove
HoD Email
example@example.com
Details of the Unpaid Leave Request
I wish to take Unpaid Leave on the following dates
Date From
*
-
Day
-
Month
Year
Date
Date To
*
-
Day
-
Month
Year
Date
Number of Days
*
Reason for request
*
Please verify that you are human
*
Submit
Should be Empty: