Leave Application Form.
Employee Name:
Employee Number:
Store/ Department:
Line Supervisor:
Type of Absence Requested:
Sick Family responsibility Compassionate Time Off Without Pay
Annual Mothers’ day Maternity/Paternity Other/ Specify
Dates of Absence: From: To:
Covering during Absence ___________________________________________________________________
You must submit requests for absences, other than sick leave/ Emergencies 14 days prior to the first day you will be absent.
Employee Signature Date
Management Approval Only
Approved
Rejected
Comments: ___________________________________________________________________________________________
Manager Signature Date