LEAVE REQUEST FORM
Employee Name: ___________________________ Date: _________________________
Dates Requested: ___________________________ No. of Days: ___________________
Type of Leave: Vacation Leave Sick Leave
Other: Paid Leave (please state) _______________
Other: Unpaid Leave (please state) _____________
To be completed by Supervisor/Manager
Supervisor/Managers Name: _______________________________________________
Signature: _____________________________________ Date: _______________________
Days remaining for the year: ___________________________________________________
LEAVE REQUEST FORM (COPY)
Employee Name: ___________________________ Date: _________________________
Dates Requested: ___________________________ No. of Days:___________________
Type of Leave: Vacation Leave Sick Leave
Other: Paid Leave (please state) _______________
Other: Unpaid Leave (please state) _____________
To be completed by Supervisor/Manager
Supervisor/Managers Name: _______________________________________________
Signature: _____________________________________ Date: _______________________
Days remaining for the year: ___________________________________________________
01/07/16
v1.0