Employee Sick Leave Affidavit

Employee Sick Leave Affidavit
To

MonthDayYear
End
Pay Period from

MonthDayYear
Start
Employee Name

First NameLast Name
Employee Email
example@example.com
I, certify that I was absent on the following day(s) Days* (List the date(s) of absence, for a total ofHours* hours. For the following reasons, Reason(s)*
Employee Signature
Upload relevant document here

Medical Report / Permissions
Cancelof
This form is to be completed upon return to work and submitted for final processing.
Form ESLA-900
Should be Empty: