Leave Request Absence Report Details

Have you ever needed to take a break from work, but weren't sure how to go about it? The leave of absence request form is the perfect way to let your employer know that you need some time away. In this blog post, we'll discuss the steps you need to take to fill out the form, and what to expect once you submit it. We'll also provide some tips for making your leave of absence as smooth as possible. So, whether you're planning a vacation or dealing with a personal emergency, read on for information on how to make a leave of absence request.

In the list, there's some good information concerning the leave of absence request form. You can learn its length, the actual time to fill out the form, the fields you'll have to fill in, and so forth.

QuestionAnswer
Form NameLeave Of Absence Request Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesleave form, leave of absence form sample, printable leave of absence form, leave request form

Form Preview Example

 

BROWN UNIVERSITY – BENEFITS OFFICE

 

 

 

LEAVE OF ABSENCE REQUEST FORM

 

 

 

 

 

 

 

 

1. EMPLOYEE INFORMATION

 

 

 

 

 

 

 

 

 

Name:

 

 

 

 

 

 

 

 

 

Campus Phone:

Campus Box:

 

 

 

 

 

 

 

 

Preferred Mailing Address During Leave*:

 

 

 

_____________________________________________________________________________________

 

 

Street

City

State

Zip

 

Telephone Number During Leave*:

Email Address During Leave (optional)*:

 

______________________________________

______________________________________

* PLEASE NOTE: You are responsible for providing a correct mailing address to be used during your leave so that the University

can contact you, as necessary. All University correspondence will be mailed to the campus or home address listed above.

Department:

Department Coordinator:

Campus Phone:

 

 

Supervisor:

Campus Phone:

 

 

2. LEAVE OF ABSENCE REASON

Own medical condition (Non work related)

Family Member’s medical condition:

Birth and care of employee’s newborn child

Spouse

Parent

Placement with the employee of a child for adoption or foster care

Child

Parent-In -Law

Military Caregiver Leave (Family Member)

Personal

 

Qualifying Exigency Military Leave (Family Member)

Military Leave (Self)

 

 

 

 

3. LEAVE INFORMATION

LEAVE DATES

PAY STATUS

NOTES

 

LAST DAY OF WORK:

 

 

 

 

(LOA will be UNPAID unless otherwise

 

 

 

 

 

 

 

 

 

 

indicated; include number of days to be

 

 

________________________________

 

 

paid, if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From: ______________

Sick Days _____

Vacation Days _____

 

To: ________________

Maternity Benefit _____

From: ______________

Sick Days _____

Vacation Days _____

 

To: ________________

Maternity Benefit _____

From: ______________

Sick Days _____

Vacation Days _____

 

To: ________________

Maternity Benefit_____

From: ______________

Sick Days _____

Vacation Days _____

 

To: ________________

Maternity Benefit _____

4. SIGNATURES

Employee’s Signature:

Date:

 

 

Authorized Department Signature:

Date:

 

 

Senior Officer Signature (if applicable):

Date:

 

 

Benefits Office, 12/12/11