Leave Request Form
How to submit a leave request
1. Fill out the leave request form with accurate details.
2. Submit the form to your direct manager for approval, with HR copied (CC) on the email.
3. Once approved, HR will verify and process the request.
4. HR will provide a copy of the approved request for your records.
Employee details
Employee name Department
Manager/Supervisor
Job title
name
Leave request details
Leave request ☐ Days ☐ Hours
Starting on Ending on
Reason for leave request
☐ Vacation ☐ Family Reasons ☐ Jury Duty
☐ Personal Leave ☐ Medical Leave ☐ To Vote
☐ Parental Leave ☐ Funeral/Bereavement ☐ Other:
I confirm that the information provided in this leave request form is accurate and complete.
I understand that this request is subject to approval by my employer.
Employee signature
Date
Notes and comments (Optional)
Employer’s decision
☐ Approved ☐ Rejected
Employer representative signature
Date
Notes and comments (For HR use only) – Do not fill up this.
☐ Used SIL ________ ☐ Remaining SIL:________ ☐ Other Leave incentive:_______