Seasonal Leave of Absence Request
Submit your request for a seasonal leave of absence from your food service position. Please complete all required fields to ensure timely processing.
Employee Full Name
*
First Name
Last Name
Employee Position/Title
*
Department or Work Location
*
Employee Email Address
*
example@example.com
Employee Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Immediate Supervisor/Manager Name
*
Type of Leave Requested
*
Personal
Medical
Family
Other
Reason for Leave (brief explanation)
*
Leave Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Leave End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is coverage arranged for your duties during your absence?
*
Yes
No
If coverage is arranged, please provide the replacement's name and contact information
Employee Signature (please sign below)
*
Submit Leave Request
Submit Leave Request
Should be Empty: