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Leaveof absence
1. Leave of Absence Request Form
__________________________________ __________________
Employee Name Date
__________________________________
Employee ID Number
Type of Leave of Absence
[ ] Medical
[ ] Military
[ ] Personal
[ ] Family Medical Leave
[ ] Others __________________
__________________________________ __________________
Start Date of Leave Return to Work Date
All medical Leaves of Absence require certification from a doctor to return to work.
__________________________________ __________________
Employee Signature Date
__________________________________ __________________
Supervisor Signature Date
__________________________________ __________________
Manager Signature Date
Route to:
[ ] Timekeeping
[ ] Payroll
[ ] Benefits
SOURCE: hrVillage.com
![Leave of Absence Request Form
__________________________________ __________________
Employee Name Date
__________________________________
Employee ID Number
Type of Leave of Absence
[ ] Medical
[ ] Military
[ ] Personal
[ ] Family Medical Leave
[ ] Others __________________
__________________________________ __________________
Start Date of Leave Return to Work Date
All medical Leaves of Absence require certification from a doctor to return to work.
__________________________________ __________________
Employee Signature Date
__________________________________ __________________
Supervisor Signature Date
__________________________________ __________________
Manager Signature Date
Route to:
[ ] Timekeeping
[ ] Payroll
[ ] Benefits
SOURCE: hrVillage.com](https://image.slidesharecdn.com/leaveofabsence-110630024119-phpapp01/85/Leaveof-absence-1-320.jpg)
