Leave of Absence Form


To be filled out by employees when they are requesting extended time away from the job



  1. When an employee wants to leave their position for >30 days the LOA form is required to be completed, submitted to administrator, approved and submitted to the proper HR representative


  1. Download and have the employee complete the following form entirely:
    Request for Leave of Absence Form - Non-FMLA.pdf
  2. Contact HR to inform them of a potential LOA
  3. Review the completed form from the employee to ensure it's complete and work with HR on next steps reviewing the form together.