Leave Request Form

LEAVE REQUEST FORM
Please complete this form for ANY leave requests. This form should be submitted two weeks in advance. By signing and submitting, the employee confirms they are aware of the leave policy, acknowledge the total time taken and must wait for the leave request to be approved or denied.
EMPLOYEE INFORMATION
Today's Date:

MonthDayYear
Employee Name:

First NameLast Name
LEAVE REQUEST
Full or partial days:

Partial DayFull DayMultiple Days
Start of Leave

MonthDayYear
Date
End of Leave

MonthDayYear
Date
Date(s) requested off:
Comments:
Employee Signature:

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Should be Empty:

LEAVE REQUEST FORM