Common use of Request for Unpaid Leave Clause in Contracts

Request for Unpaid Leave. Employee: Job Classification: Job Site: I hereby request day(s) or hour(s) of unpaid leave from to on Time Time Date Unpaid Leave being requested: Unpaid Leave Association Leave Parental Leave Military Leave Court Leave Disability Leave Family Medical Leave Reason for Request: Request Date Date Received: Facility: Area or Equipment: Concise statement of immediate health/safety concern: Supervisor’s Response: Employee: Job Classification: Work Site: Date: Supervisor: Incident leading to damage of property (be specific): List damaged property: Employee: Reviewer: Position: Position: Date: Date Discussed:

Request for Unpaid Leave. Employee: Job Classification: Job Site: I hereby request day(s) or hour(s) of unpaid leave from to on Time Time Date (Time) (Time) (Date) Unpaid Leave being requested: Unpaid Leave Association Leave Parental Leave Military Leave Court Leave Disability Leave Family Medical Leave Unpaid Emergency Leave Reason for Request: Request Date Date Received: Employee Signature‌ Facility: Area or Equipment: Reporting employee Person who received this report Date Submitted Concise statement of immediate health/safety concern: Signature Supervisor’s Response: Employee: Job Classification: Work Site: Date: Supervisor: Incident leading to damage of property (be specific): List damaged property: Employee: Reviewer: Position: Position: ’s Signature Date Supervisor’s Signature Date: Date Discussed: