Leave Request Form Template
For the big absences — parental, medical, military — a formal request with documentation and a signature, handled with the care it deserves.
This form is for extended or protected leave. Answer what you can — HR will confirm eligibility, paperwork, and pay details with you directly, in confidence.
Your best estimate — it can be revised with HR later.
Shared only with HR and your direct manager.
Medical certificates, official notices — PDFs or photos, up to 3 files.
Extended leave is not PTO, and treating it like PTO is how companies end up improvising through the most sensitive moments in an employee's life. Parental, medical, family-care, and military leave each carry their own eligibility rules, documentation requirements, and — in many jurisdictions — legal protections. This form gives those requests a formal front door: structured enough that HR can act, humane enough that a person in a hard week can fill it in.
Why these fields. The leave category drives everything downstream, because the paperwork for parental leave and the paperwork for military duty share almost nothing; classifying up front means HR opens the right playbook on day one. Start and return dates are split, and the return date is explicitly labeled an estimate — pretending anyone knows their exact return from medical leave is false precision, and saying so in the field description lowers the anxiety of answering. The reason field states exactly who reads it, which is the single most important sentence on the form: disclosure scales with stated confidentiality. The documentation upload accepts certificates as photos because people are often submitting from a phone in a waiting room. The manager-discussion question, with its option to let HR make the introduction, acknowledges a real dynamic — some leave is easier to raise with HR first. The signature makes the request a record, which protects the employee as much as the employer.
What we left out. Pay calculations, benefit continuation elections, and jurisdiction-specific statutory forms. Those follow from eligibility, which HR has to determine anyway — asking employees to self-assess their legal entitlements up front produces wrong answers and false expectations.
Who uses this. HR teams of one at growing companies, nonprofits and clinics with statutory-leave obligations, and any organization that has learned the hard way that "email HR when something big happens" leaves gaps precisely when precision matters.
Make it yours. Rename categories to match your policy and country. In the Logic panel, add category-specific follow-ups — an expected due date for parental leave, deployment orders for military duty — so each path asks only what it needs. Because the answers are sensitive, consider password-protecting the link and keeping email notifications off for this one; the responses dashboard is the safer reading room. A signed webhook can quietly open a case in your HR tracker the moment a request arrives, so the three-business-day promise in the ending never slips.
Frequently asked questions
Who can see what an employee submits here?
Only the form owner sees responses in the dashboard. The form itself promises the reason is shared with HR and the direct manager — keep that promise in your process.
Can employees add medical certificates later?
Yes — accept the request without documents, then have them submit again with just the upload attached. Files up to 10MB each are supported.
Does the signature block create a real signature?
The signature block captures a drawn signature image stored with the response — a clear record of intent for internal leave paperwork.
Can different leave types ask different questions?
Yes — add rules in the Logic panel, like showing an expected due date question only when parental leave is selected. Everyone else never sees it.