Leave of Absence Request
Please fill out the form below and make sure you upload any relevant documentation. Please note that this form is to be used for extended leaves of absence (over 2 weeks). For anything less than that, you should use the regular time off request procedure in the Wellsky App.
Employee Name
*
First Name
Last Name
Today's Date
*
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Month
-
Day
Year
Date
Details of Leave
Leave Start
*
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Month
-
Day
Year
Date Picker Icon
Leave End
*
-
Month
-
Day
Year
Date Picker Icon
Reason for Absence
*
Please upload any supporting documentation
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Signature
*
Submit Leave of Absence Request
Submit Leave of Absence Request
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