Leave of Absence Request Letter - Template, Sample Form

✓ Valid in United States

Create your Leave of Absence Request Letter - Template, Sample Form for use in United States. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share.

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Leave of Absence Request Letter - Template, Sample Form

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________, ________
________

________

________
________
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Re: Request for Leave of Absence

Dear ________,

I am writing to formally request a leave of absence from my duties as ________ at ________, effective from ________ to ________. The purpose of this leave is the following:

________

During my absence, I will be using ________ of paid leave time given to me by the Company. I will be using ________ of FMLA leave during my absence. During this time, I will continue to communicate with the appropriate teams and supervisors and/or provide updates about ongoing projects if necessary.

I have attached any necessary documentation to support my request, including the following forms:

________

I am committed to providing any additional information or documentation that may be required to process my request promptly.

Thank you for considering my request. I value my role at ________ and look forward to returning to work as soon as possible.

Sincerely,

________, ________

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