HR - Leave of Absence Request Form

HR - Leave of Absence Request Form
Full Name*

First NameLast Name
DM and Store #*
Position*
Last 4 of Social #*
TM Email*
example@example.com
Leave Start Date*

MonthDayYear
Date
Leave End Date*

MonthDayYear
Date
Leave Type
FMLA (Select Reason)
Eligibility Requirement: 1 year of service
PERSONAL LEAVE (Select Reason)
Attach Backup Documents

Cancelof
Approved by DM

YESNO
DM Name
District Manager Sign and Date*

Clear
DO Name
Director of Operations Sign and Date

Clear
HR EMAIL