Sickness Leave Form

Sickness Leave Form
How many working days are you applying for sickness leave?
Start Date
MonthDayYear
Date
End Date
MonthDayYear
Date
Employee Name
First NameLast Name
Employee ID
Position
Department
Reason for Sickness Leave
Reminder: If the sick leave is more than 3 days, a fit-to-work certificate from the doctor is needed in order to get back to work.
By signing below, I confirmed that all information in this form is true and accurate.
Employee's Signature
Clear
Date Signed
MonthDayYear
Date
Approval Status
ApprovedDisapproved
Reason why it was disapproved
Supervisor Name
First NameLast Name
Supervisor's Signature
Clear
Date Signed
MonthDayYear
Date
Should be Empty: