Leave of Absence Form Template

ADS

Free
Download Template
License: Free More info
Attribution: Required How to attribute?

Generally speaking, a leave of absence is a formal, job-protected right to be absent from work, available to US citizens going through certain extraordinary life events. From childbirth and adoption, to serious health conditions, educational pursuits, or military duty. In some of these situations, employees have a right to leave as a matter of federal & state law, while other leave types are part of internal organizational or HR policies.

The bottom line is that a leave of absence leaves your employee job-secure. So, as managers or owners, you can’t simply decide to replace or terminate them while they’re away.  Note also that, unlike annual leaves, vacations, or Paid Time Off, a leave of absence is unpaid, with some exceptions in case of military leaves. Remember, not granting a leave of absence even if an employee fulfills the criteria under relevant laws, such as the FMLA, can trigger formal legal action against you.

As a company, therefore, you must know the difference between a simple leave and a LoA to comply with applicable laws. Knowing this is important for HR managers when developing a formal leave program.

Why Bother?

The truth is, if you don’t comply with leave laws, employees can sue you & labour departments can come in to investigate, possibly leading to regulatory fines or other penalties. From an organizational growth perspective, having a clear and compliant leave policy also helps retain top talent and fosters a supportive work environment. So yeah, there’s more than one good reason to formalize the leave process in your company.

What We Offer

We offer a premade form you can use to accept formal leave requests from employees. Our pre-standardized template covers all legally relevant categories of leave (for the U.S), plus those found in general HR policies.  Of course, you can edit them to keep only those leaves that apply to your organization. 

For a detailed breakdown of leave laws in the U.S., read our complete blog here!

Here’s a quick process breakdown to guide you through the process of requesting, processing, and implementing a leave of absence:

  • Step 1: Create a formal leave policy for your organization in light of relevant laws (federal and state laws) as well as the nature of the business, company size, etc.
  • Step 2: Clearly outline the final leave policy in your employee handbook. Share the handbook with all new employees during the onboarding process and make sure the policies are easily accessible.
  • Step 3: Tailor our leave of absence form template to your organizational policies and local laws. You can add, delete, or replace leave categories as per your needs & requirements.
  • Step 4: The employee fills out this form and formally submits a leave of absence request.
  • Step 5: The HR department or manager shall review each leave request on its own merits. Based on an assessment of facts, laws, and internal policies, the HR manager may decide to approve or deny a leave request on a case-by-case basis.

Now, let’s take a closer look at our pre-made Leave of Absence Form.

Employee Details

First, cover the essentials! Use this section to ask for basic information about the employee, including their name, position, contact details, and Employee ID (if applicable).

This ensures that there is no doubt later on about who requested the leave and that all information provided in the form can be archived in the employee’s file for internal record-keeping, tax, and auditing purposes.

Employee Details in Leave of Absence Form Template.Pin

Reason for Leave

Here, ask employees to specify the reason or substantive ground for the leave.

If a leave qualifies under the FMLA, they must select the first option. 

For those who don’t know, the Family and Medical Leave Act requires you (as employers operating anywhere in the U.S.) to give 12 weeks of unpaid, job-protected leave when employees are:

  • Pregnant
  • Experiencing the birth of a baby
  • Adopting a new child
  • Caring for an ill family member
  • Going through serious health conditions
  • Called for active duty or military service

Depending on their situation, employees must check the relevant box. 

Here are some frequently asked questions about FMLA leaves that you might find helpful…

Do FMLA Rules Apply to All Companies?

No! FMLA only applies to companies with 50 or more employees, working within a 75-mile radius of the worksite.

Which Employees Qualify for Leave under FMLA?

If you want to apply for an FMLA leave, you must have completed 20 or more work weeks with the employer during the current or past calendar year. 

Are Leaves under FMLA paid?

No. FMLA leaves are generally unpaid. A company is only required to pay employees if they have available paid time off or sick time and they choose to use it. Or if there’s a policy that requires the use of paid time off prior to leaves progressing as unpaid. 

Now, if an employee doesn’t qualify under FMLA, they have access to a second option – that is, Personal Leave.

But, What’s a Personal Leave?

A personal leave is time off work taken for non-medical, non-vacation-related reasons. Unlike FMLA leaves, companies don’t need to grant personal leaves as a matter of law. In most cases, they are unpaid unless otherwise specified by company policy.

In our form, we use five default grounds for a personal leave used by employees to claim absence from work:

  • Educational (say, they want to pursue an educational degree or diploma)
  • Medical (e.g., to focus on their mental health if their condition is not covered under FMLA or general sick leave)
  • Maternity Leave
  • Paid Parental Leave
  • Military Leave

We also added an ‘Other’ option in case your reason for leave is not covered under any of the categories above.

It’s important to note that a personal leave is not the same as a:

  • FMLA Leave – which is protected by law and only meant for specific family or medical needs.
  • Sick Leave – used for illness or injury.
  • Vacation – scheduled (usually paid) time off for rest or recreation.
Leave Details in Leave of Absence Form Template.Pin

Type & Duration

Once employees declare the reason for their requested absence, it’s time to nail down the specifics of each requested leave.

With a little editing, you can customize this checklist according to your applicable laws and relevant organizational policies.

For each leave type, employees must specify the duration of the leave in the placeholders provided. This can be important when you don’t want to use up all your leaves in a certain category.

Employees must select the type of leave category relevant to them from the five categories in our form:

  • Sick leave 
  • Paid Time Off
  • Vacation
  • Casual leave
  • Leave without pay

Let me explain…

Breaking down work absence by leave category

Our default configuration lets you break down your absence by leave category. Some leave categories are paid, while others are not; you will have to check with HR to find out.

Here’s why breaking down your absence by leave type is helpful:

Let’s say John, one of your employees, caught a minor eye infection. His G.P. advised him to take a week off from work. But the problem is, John can’t afford to lose a week’s worth of salary. What does he do? Well, he can choose to use a combination of paid and unpaid leave categories in a way that he is paid for at least, say, 2 to 3 days of the week. Our form allows you to cut & crop dates to best suit individual employee needs & preferences.

From an organizational PoV, this section also ensures that the organization can accurately track different types of absences for each employee, and update their leave balances accordingly. 

Additional Details

This section asks the employee to clarify the type and status of the leave. The employee must choose one of the following options depending on their situation:

☐ New Request: Select this option if it’s the first time a particular leave is being requested.
☐ Update to Existing Request: Check this box if the employee is making a change to a previously submitted leave request (e.g., changing dates or switching from continuous to intermittent).
☐ Continuous Leave: Select this option if leave is to be taken all at once, without breaks (e.g., two weeks off in a row).
☐ Intermittent Leave: Check this box if leave is to be taken in segments (e.g., a few days each week or specific dates over time).

Total no. of leaves.

Here, prompt employees to specify if they’re reporting the total leave in Days or Weeks. They must also specify the exact number of days or weeks for which the leave of absence is being granted.

Reason for leave

This is an open space where employees are expected to explain why they are requesting a leave of absence. For example, they may need to be away from work due to a family emergency, for religious observance, or to attend legal proceedings as a witness or jury, as the case may be.

Leave schedule

Now, just in case employees select the option ‘Intermittent Leave’, they will also need to describe their proposed leave pattern. For example: “Mondays and Wednesdays off for the next three weeks”, or “Half-days every Friday for medical appointments”. 

From an HR point of view, this information is critical for scheduling and planning work. It also helps HR better understand the context of the leave request and make informed decisions accordingly. 

Types & Duration and Additional Details in Leave of Absence Form Template.Pin

Supporting Documentation

For certain types of leave, you must ask employees to attach certain documents as proof of their reason for leave. Whether a leave is to be granted as a matter of law or as part of company policy, you will need access to relevant supporting documents to verify the contents of each leave request.

This section allows you to:

  • Clarify if any documentation is attached to the form or not
  • Create a list of documents attached to back up their leave request

Here’s a detailed look at the kind of documentation you need when applying for different leave categories under the FMLA:

Type of FMLA LeaveSupporting Documents Required
Serious Health Condition (Employee) Medical certification from a healthcare provider (Form WH-380-E)
Doctor’s note (optional)
Serious Health Condition (Family Member) Medical certification from family member’s healthcare provider (Form WH-380-F)
Proof of relationship (if requested)
Parental Leave (Birth, Adoption, Foster Care) Birth certificate or hospital documentation
Adoption or foster care placement papers
Military Family Leave (Qualifying Exigency) Military active duty orders
Certification of exigency (Form WH-384)
Military Caregiver Leave Certification for serious injury or illness of a covered servicemember (Form WH-385 or WH-385-V)
Proof of relationship (if requested)
Intermittent Leave Medical certification indicating need for intermittent schedule
Pregnancy-Related Leave Medical certification confirming pregnancy-related health condition

Acknowledgement

Once employees have filled out all relevant leave details, it’s time to submit the request to HR. But before you accept the form, make sure employees have signed & dated it, and provided all the requisite information.

By signing this form, employees acknowledge that the information provided is true to the best of their knowledge. They also agree to adhere to the employer’s policies and applicable laws for requesting leave while providing any necessary documents if required.

Supporting Documentation and Acknowledgment in Leave of Absence Form Template.Pin

For HR Use

Unlike the rest of the form, which may be filled out by employees or HR, this section is designed for use by an HR manager or official only.

HR can use this section to:

  • Find out if the employee has used any FMLA leave in the past 12 months
  • Collect details about the days/hours of FMLA leave they have used up 
  • Ask for supporting documentation (if applicable) 

Leave decision

This is where the HR manager or a senior company official makes the final decision about the leave of absence request. They may approve or deny the request based on their assessment of relevant laws and company policy, as weighed out on a case-by-case basis. 

HR Department Use Only in Leave of Absence Form Template.Pin

What’s Next?

Organizations must ensure that all leave requests are handled in a fair, transparent, and unbiased manner. Supervisors and HR teams must be vigilant to avoid doing anything that could infringe upon an employee’s contractual rights or discriminate against them based on gender, race, religion, or any other protected characteristic. 

Employees must also be informed that if and when they believe their rights have been violated, they have the option to escalate the matter to the internal disciplinary committee or pursue legal action if necessary.

HR officials need to give employees written confirmation of leave approvals or denials. This protects both the organization and the employee in the event of any future disputes regarding leave dates, eligibility, or return-to-work arrangements. 

To ensure smooth workforce planning, HR should encourage employees to promptly notify the organization of any changes to their expected return dates.

Summary

A Leave of Absence Form is used by employees to request time off from work for a specific period. It covers employee details, reason for the leave, requested dates, and any supporting documentation. A premade form provides a standardized way for employees to request leave, helping employers manage absences by clearly outlining who will be away and for how long, reducing confusion and ensuring consistency. Leaves may be paid or unpaid, depending on the reason and company policy. Unpaid leave often begins once an employee has used all available paid time off. All in all, having a well-defined policy ensures fairness, supports employee well-being, and helps maintain smooth business operations.

Technical Note

For your ease, our templates are available in multiple file formats, including Microsoft Word for easy offline editing, OpenDocument (ODT or ODS) for compatibility with various word processors, and via Google Docs for cloud-based sharing, editing, and collaboration.

These templates are fully editable and can be customized to your needs and requirements, making them ideal for organizations of any nature, size, and complexity. 

You may also like

See all