LEAVE ABSENCE FORM
Employee Information Leave Details
Employee Name: Type of Leave:
_____________________________________ ______________________________________
Employee ID: Dates of Leave:
______________________________________ ______________________________________
Department: Number of Days:
______________________________________ _____________________________________
Reason for Leave
Briefly explain the reason for your leave:
____________________________________________________________________________________
_______________________________________________________________________.
Request for Leave
Do you request approval for your leave? ⬜ Yes ⬜ No
If yes, please provide supporting documents (if applicable): ____________________________
Contact Information
In case of an emergency, please contact: _______________________________
Phone Number: ______________________________________
Email Address: ______________________________________
Signature
I hereby certify that the above information is true and accurate. I understand that any
false or misleading information provided may result in disciplinary action.
Employee’s Signature: ______________________________________
Date: _____________________________________
Approved by:
Manager/Supervisor Signature: ______________________________________
Date: ______________________________________
