Newborn Care Leave of Absence Request
Submit your request for a leave of absence due to newborn care. Please complete all required fields and attach supporting documents.
Applicant's Full Name
*
First Name
Last Name
Employee ID
*
Position/Job Title
*
Department/Unit
*
Supervisor/Manager Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Requested Leave Start Date
*
-
Month
-
Day
Year
Date
Requested Leave End Date
*
-
Month
-
Day
Year
Date
Reason for Leave (Newborn Care Details)
*
Newborn's Full Name
*
First Name
Last Name
Newborn's Date of Birth
*
-
Month
-
Day
Year
Date
Relationship to Newborn
*
Mother
Father
Legal Guardian
Other
Supporting Document (e.g., birth certificate)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Submit Request
Submit Request
Should be Empty: