Leave Request Form Example
Example document for Leave Request Form. Use this as a reference when creating your own.
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Document: Leave Request Form
Example Document
Last updated 7/30/2026
Leave Request Form
Employee Details
- Full Name: Jack Smith
- Job Title: Electrician
- Employee ID: ES-045
- Date of Request: 15/03/2024
Leave Details
- Type of Leave: Annual Leave
- Start Date: 10/04/2024
- End Date: 24/04/2024
- Return to Work Date: 25/04/2024
- Total Days / Hours Requested: 10 Days (80 Hours)
- Reason for Leave: Family holiday to Queensland.
Attachments
- Supporting Evidence Attached? No
Public Holidays
- Public Holiday Dates: 25/04/2024 (Anzac Day)
Contact Details During Leave
- Emergency Contact Number: 0400 123 456
- Email Address: jack.smith@email.com
Employee Declaration I declare that the information provided is true and correct. I understand that I must follow company policy regarding notification and evidence for leave.
Employee Signature: J. Smith Date: 15/03/2024
Manager / Employer Section
Leave Balance Check
- Current Annual Leave Balance: 18.5 Days
Decision
- Approved [x]
- Not Approved [ ]
- Approved with Conditions [ ]
Reason for Referral or Condition (if applicable): N/A
Manager / Authorised Signature: Sarah Jones Date: 16/03/2024
HR / Payroll Use Only
- Processed in Payroll: Yes
- Pay Period Affected: Fortnight ending 26/04/2024
Notes
Example Notes:
- Employee Identification: The employee has provided their full name, ID, and job title to ensure the correct person is recorded.
- Leave Type: Jack has clearly selected Annual Leave. This is important because it is paid leave and comes out of his specific annual leave balance.
- Dates: The dates cover a 2 week period. The return date is correct, allowing him to start work the day after the leave ends.
- Public Holidays: Jack has noted Anzac Day falls on the day he returns. Because he is not working on that day, the employer must pay him for the public holiday, not charge it to his annual leave balance.
- Evidence: For annual leave, evidence is not usually required, so 'No' is ticked.
- Approval: The manager checked the leave balance (18.5 days available) and approved the request. The signature confirms the business accepts the time off.
About this Example
Part of the Leave Request Form document collection
Document Type
Leave Request Form
A standard document used by employees to formally ask their employer for time off. It records the type of leave, dates, and reasons to ensure proper payment and staff coverage.