Leave Request Form Template
For the big absences, parental, medical, or 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, and HR will confirm eligibility, paperwork, and pay details with you one on one, in confidence.
Your best estimate, and you can revise it with HR later.
Shared only with HR and your direct manager.
Medical certificates or official notices, as PDFs or photos, up to 3 files.
Extended leave works nothing like PTO, and treating the two the same 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 places, legal protections. This form gives those requests a formal front door, structured enough that HR can act on it and humane enough that a person in a hard week can still fill it in.
Reading it field by field. The leave category drives everything downstream, because the paperwork for parental leave and the paperwork for military duty share almost nothing, and sorting it up front means HR opens the right playbook on day one. Start and return dates are split, and the return date is labeled an estimate on purpose. Pretending anyone knows the exact day they will come back from medical leave is false precision, and saying so in the field description lowers the anxiety of answering. The reason field names who reads it, the single most important sentence on the form, since disclosure scales with stated confidentiality. The documentation upload takes certificates as photos because people often submit from a phone in a waiting room. The manager-discussion question, with its option to let HR make the introduction, respects a real dynamic: some leave is easier to raise with HR first. The signature turns the request into a record, which protects the employee as much as the employer.
Not on this form. Pay calculations, benefit-continuation elections, and jurisdiction-specific statutory forms stay off it. Those follow from eligibility, which HR has to determine anyway, and asking employees to self-assess their legal entitlements up front produces wrong answers and false expectations.
Who relies on it. HR teams of one at growing companies, nonprofits and clinics with statutory-leave obligations, and any organization that learned the hard way that "email HR when something big happens" leaves gaps right when precision matters.
Shape the paths. Rename categories to match your policy and country. In the Logic panel, add category-specific follow-ups, an expected due date for parental leave or deployment orders for military duty, so each path asks only what it needs.
Guard the sensitive answers. These answers are sensitive, so password-protect the link and keep email notifications off for this one; the responses dashboard is the safer reading room. A signed webhook can 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 promises the reason goes to HR and the direct manager, so keep that promise in your process.
Can employees add medical certificates later?
Accept the request without documents, then have the employee submit again with only 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?
Add rules in the Logic panel, like showing an expected-due-date question only when parental leave is selected. Everyone else never sees it.