Leave request (not holiday)

Name:  
Department:  

DATES REQUESTED

PLEASE NOTE: First day and Last day means your first and last days of leave; Last day does not refer to your first day back at work after your leave.

[Shift Workers: Please count only those days you would have been scheduled to work (including Sats/ Suns/Bank Holidays). Do not include your normal off days in the number of days to be deducted.]

If taking a half day, specify AM or PM in the appropriate box(es).

First day of leave (date):  
Last day of leave (date):  
Total number of [days|hours] taken:  
Reason for leave:  

I have read and understood the [Company Absence] policy and have completed this form in accordance with the appropriate guidance.

Signed (employee):  
Date:  
Approved (line manager):  
Date: