Film Production Family Leave of Absence Form
Request a family leave of absence from your film production role. Please complete all sections for your request to be processed.
Employee Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Job Title / Department
*
Supervisor or Production Contact Name
*
Type of Family Leave Requested
*
Parental Leave
Medical Leave (Family Member)
Bereavement Leave
Other
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
Reason for Leave (please provide details)
*
Will you be attaching supporting documentation? (e.g., medical note, birth certificate)
*
Yes
No
Upload Supporting Documentation (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Signature (please sign to acknowledge your request)
*
Submit Leave Request
Submit Leave Request
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