Sickness Leave Form

Sickness Leave Form
How many working days are you applying for sickness leave?
Start Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
Approval Status
Reason why it was disapproved
Supervisor Name
First NameLast Name
Supervisor's Signature
Clear
Date Signed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: