Personal Leave Request Form template



How to create a Personal Leave Request Form for your organization? We provide a Personal Leave Request that fits your needs!

Make use of this sample leave letter template to help to come to a perfect personalized version. The objective of this form is to provide a solution for a request for a leave of absence to your staff. This letter is to request a period of leave for a temporary or permanent leave. When you require a Personal Leave of Absence, there could be several reasons, for example:

  • Medical: If you are requesting a medical leave of absence but are not eligible for FMLA, you are required to submit a Certification of Health Care Provider form. If your leave is approved, it will be counted against your FMLA entitlement. The Health Care Provider form must be submitted only to the Human Resources Department.
  • Non-Medical: Please explain, e.g. family emergency, personal business, below.
The following Names, Functions, and Signatures are relevant:
  • Employee Signature & Date
  • Employee Name
  • Immediate Supervisor
  • Signature & Date
  • Immediate Supervisor Name
  • Department Head Signature & Date
  • Department Head Name

Please understand that if you are creating a leave request form. Please note this form is provided for guidance only. Download this Personal Leave Request template to make a perfect (and personalized) form, edited to fit your organization. If this form does not fit your requirements, please also have a look at the topic: Leave Letter Templates.


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