Sample Leave Form

June 27, 2011

Employees may at times require leave from their jobs. It is recommended that one must fill in a leave form which is normally availed by the HR department in most organizations. The form is also important for documentation purposes. Apart from that, it also helps the hr department to keep records of holidays and leave taken by the employees. Shown below is a sample leave form.

Sample Leave Form


Name of Employee ______________________

Department ____________________________

Social security number ___________________

Date of request __________________________

Category of Leave Requested

Paid leave _____________ Unpaid leave ___________

Other ____ Explain _______________________________________________________

_______________________________________________________________________

Reason for Leave

Vacation/personal leave _____________

Ill Family Member _________________

Employee’s own illness ______________

Care for new child __________________

Other _________ Explain __________________________________________________

_______________________________________________________________________

Start date of leave _____________________________

End date of leave _____________________________

Address during leave __________________________

Phone number during leave _____________________

Special circumstance Explain ______________________________________________

______________________________________________________________________

Employee signature __________________________ Date ___________

 

Download Sample Leave Form in Word Format

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