Request for Leave of Absence Form
Personal Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Position
Employee No.
Supervisor Name
First Name
Last Name
Details of Leave/Absence
From
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
Leave/Absence Type
Please Select
Reason 1
Reason 2
Reason 3
Reason 4
Other
Email during leave
example@example.com
Phone during leave
Additional Comments
Submit
Should be Empty: