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    Leave Request Form

    Uploaded by

    Toya Nonyah
    This leave request form requires employees to provide information about requested time off including number of days, dates, and reason for leave. The employee must sign acknowledging they will first use accrued sick and vacation days during leave and any remaining time will be unpaid. Management will then approve or deny the request and note any remarks before human resources tracks remaining leave balances.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Leave Request Form

    Uploaded by

    Toya Nonyah
    195 views1 page
    This leave request form requires employees to provide information about requested time off including number of days, dates, and reason for leave. The employee must sign acknowledging they will first use accrued sick and vacation days during leave and any remaining time will be unpaid. Management will then approve or deny the request and note any remarks before human resources tracks remaining leave balances.

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    Leave Request Form

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    This leave request form requires employees to provide information about requested time off including number of days, dates, and reason for leave. The employee must sign acknowledging they will first use accrued sick and vacation days during leave and any remaining time will be unpaid. Management will then approve or deny the request and note any remarks before human resources tracks remaining leave balances.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    195 views1 page

    Leave Request Form

    Uploaded by

    Toya Nonyah
    This leave request form requires employees to provide information about requested time off including number of days, dates, and reason for leave. The employee must sign acknowledging they will first use accrued sick and vacation days during leave and any remaining time will be unpaid. Management will then approve or deny the request and note any remarks before human resources tracks remaining leave balances.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    LEAVE REQUEST FORM

    Required for Full-Time employees working 30 hours + per week

    Employee Name: ________________________ Branch: _________ Title: _______________________

    SECTION I: DESIRED LEAVE DATES


    I am requesting the following dates off duty:

    # of Days: ______ Date(s): from____________ to_____________ ❏ Full Day ❏ Half Day

    # of Days: ______ Date(s): from____________ to_____________ ❏ Full Day ❏ Half Day

    # of Days: ______ Date(s): from____________ to_____________ ❏ Full Day ❏ Half Day

    SECTION II: REASON FOR REQUESTED LEAVE


    ❏ Vacation ❏ Sick Leave ❏ Bereavement ❏ Birthday

    ❏ Personal ❏ FMLA ❏ Other: _____________________________


    Notes: ____________________________________________________________________________
    __________________________________________________________________________________
    SECTION III:
    I understand I will be required to use my accrued sick and vacation days if I am provided such, as part of my leave of
    absence. After I have exhausted my sick and vacation days, I understand the remainder of the leave will be without pay.
    I also understand that if I fail to return to work after the expiration of the leave, I will be terminated unless prior notice
    has been provided to the company extending my leave.

    Employee Signature: __________________________ Submission Date:______________

    TO BE COMPLETED BY MANAGEMENT

    The above request has been: ❏ Approved ❏ Denied


    Remarks:_________________________________________________________________________

    Manager/Supervisor Signature: _____________________________ Decision Date: _____________

    HUMAN RESOURCE DEPARTMENT

    Remaining Leave Balance: ______hrs. ______hrs. ______hrs. ______hrs. ______hrs.


    Vacation Sick Personal Birthday
    Remarks:_________________________________________________________________________

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