Employee Assistance Program Approval Form
Please fill out this form to request approval for the Employee Assistance Program.
Employee Full Name
First Name
Last Name
Employee ID
Department
Please Select
Human Resources
Finance
Marketing
Sales
IT
Operations
Customer Service
Other
Supervisor Name
First Name
Last Name
Date of Request
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Assistance
Supervisor Approval
Approved
Denied
Pending
Supervisor Signature
Submit
Should be Empty: