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Leave Request Form
Use this form to file a leave request with Elite VA Society. Paid leave eligibility and applicable leave balances will be determined based on your current records.
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1
Email Address
*
This field is required.
Use the email address associated with your Elite VA record.
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2
Client Assignment — Charm
*
This field is required.
Select the client this leave request applies to.
Landon Mabe
Star Leal
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3
Client Assignment — Jennalyn
*
This field is required.
Select the client this leave request applies to.
Debbie Bradley
Taley Hunt
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4
Work Schedule
*
This field is required.
Full-Time
Part-Time
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5
Leave Type
*
This field is required.
Select the type of absence you are requesting.
Paid or unpaid classification will be determined automatically based on your available leave balance.
Personal Leave
Sick Leave
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6
Leave Duration
*
This field is required.
Select whether the requested dates are full working days or half working days. Half Day(s) are counted as 0.5 leave day for each eligible workday in the selected date range.
Full Day(s)
Half Day(s)
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7
Leave Date Type
*
This field is required.
Single Date
Multiple Dates
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8
Personal Leave Date
*
This field is required.
-
Date
Year
Month
Day
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9
Sick Leave Date
*
This field is required.
-
Date
Year
Month
Day
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10
Personal Leave Start Date
*
This field is required.
-
Date
Year
Month
Day
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11
Personal Leave End Date
*
This field is required.
-
Date
Year
Month
Day
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12
Sick Leave Start Date
*
This field is required.
-
Date
Year
Month
Day
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13
Sick Leave End Date
*
This field is required.
-
Date
Year
Month
Day
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14
Start Date
*
This field is required.
-
Date
Month
Day
Year
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15
End Date
*
This field is required.
For a one-day leave, select the same date as the Start Date.
Half Day(s) are counted as 0.5 leave day per eligible date selected.
-
Date
Month
Day
Year
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16
Has your client already approved this leave request?
*
This field is required.
Yes, my client has approved.
No, I still need client approval.
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17
Proof of Client Approval
Upload a screenshot or other proof showing your client’s approval for records purposes.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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18
Reason/Notes
*
This field is required.
Briefly provide the reason or any relevant context for this leave request for our records.
Please keep it concise and include only information necessary to document the leave.
Please do not include sensitive medical details.
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