Hospitality Burnout Leave of Absence Form
Request a leave of absence due to burnout. Please complete all sections to ensure your request is processed efficiently.
Employee Full Name
*
First Name
Last Name
Employee Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Job Title
*
Department/Work Area
*
Please Select
Front Desk
Housekeeping
Food & Beverage
Management
Maintenance
Events
Other
Supervisor/Manager Name
*
Start Date of Requested Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date of Requested Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please indicate the primary symptoms or reasons for your burnout (select all that apply):
*
Emotional exhaustion
Physical fatigue
Reduced performance
Difficulty concentrating
Increased irritability
Feeling detached from work
Other
Please describe how burnout has affected your ability to perform your job duties.
*
If you have supporting documentation (e.g., doctor's note), please upload it here.
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