Employee Leave Request Form
Employee Details
Todays Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Name
*
Your Full Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Employee Email address
*
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Leave Details
Reason for Leave
*
Please Select
Annual Leave - Paid
Annual Leave - Unpaid
Sick Leave
Career's Leave
Bereavement Leave – Immediate Family
Parental Leave – Primary Career
Community Service Leave (e.g. Jury Duty, Emergency Services)
Domestic & Family Violence Leave
Leave Without Pay – Other
Time Off in Lieu (TOIL – Approved)
Other
Leave requested from
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Leave requested Till
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Total number of hours requested
*
Total number of days requested
*
Return to work Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Notes/Comments
*
Type a short description
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Office Use Only
Outcome
*
Approved
Denied
Comments
Checked by:
*
Manager Signature
*
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: