Absence request form

[Company Name]

Absence RequestAbsence InformationEmployee Name:

Employee Number:

Department:

Manager:

Type of Absence Requested:

|_|Sick|_|Vacation|_|Bereavement|_|Time Off Without Pay

|_|Military|_|Jury Duty|_|Maternity/Paternity|_|Other

Dates of Absence: From:To:

Reason for Absence:

You must submit requests for absences, other than sick leave, two days prior to the first day you will be absent.

Employee SignatureDate

Manager Approval|_|Approved

|_|Rejected

Comments:

Manager SignatureDate