Leave Request Form - S.brooks & Associates, Inc.
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1Leave Request Form
EMPLOYEE REQUEST
Last:
First:
1. Employee Name
Client:
City, State:
2. Job Assignment
3. Leave Type
Leave Starting
Leave Ending
Return Date
Total Hours
(check all applicable)
Date
Time
Date
Time
Accrued Paid Time Off
(PTO)
Unpaid Leave
4. Purpose:
Sick
Care of family member
Doctor appointment for requesting employee
Other ________________________________
5. Comments:
Date:
Employee Signature
:
EMPLOYER RESPONSE
Official Action:
Approved
Acknowledged
Denied
Employer Comments:
Employer Signature:
Date:
PAY PERIOD
Jan
Feb
Mar
Apr
May
Jun
2013
2014
Jul
Aug
Sep
Oct
Nov
Dec
2015
2016
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Parent category: Business