Leave of Absence Notification

Please complete this form within 24 HOURS of being notified that an employee may need or is requesting Leave of Absence.
Employee Information
Employee Name*
First Last
Employee Location*
Job Title*
Leave Request Details
Date Manager/Supervisor was Notified:*
MM slash DD slash YYYY
Expected Start Date of Leave:*
MM slash DD slash YYYY
Expected Return Date (If Known):*
MM slash DD slash YYYY
Type of Leave Requested:*
Manager/Supervisor Information
Manager/Supervisor Name Submitting Form*
First Last
Date Submitted*
MM slash DD slash YYYY
Manager/Supervisor Email Address*

We Do Business Your Way!^™