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Free Leave Request Form Templates

Free leave request form templates for small business: general, PTO, vacation, sick, bereavement, unpaid, and leave of absence. Download as DOCX. No signup.

Leave Request Form Templates

Seven free employee leave request form templates for small business: a general master form plus PTO, vacation, sick, bereavement, unpaid, and leave of absence versions. Download as Word with the fields, approval trail, and FMLA notes built in. No signup.

A leave request form is how an employee formally asks for time off and how a manager approves or denies it. For a small business, it replaces scattered texts and hallway conversations with one consistent record of who asked for what and whether it was granted. Written well, it keeps leave organized and fair; handled loosely, it becomes the gap that turns a routine request into a dispute nobody can settle.

These seven templates cover the range: a general master form with leave-type checkboxes, plus dedicated PTO, vacation, sick, bereavement, unpaid, and leave of absence versions. Each downloads as a Word document, free and without an email, with the fields, approval trail, and, where it matters, the FMLA and confidentiality notes built in. Because leave sits next to time off and attendance, this pairs with your time off policy and your employee attendance sheet.

TL;DR
A leave request form is the document an employee uses to request time off and a manager uses to approve it, capturing the leave type, dates, total days, and signatures. Pick the form that fits: a general master with checkboxes, or a PTO, vacation, sick, bereavement, unpaid, or leave of absence version. Download all seven free as Word, with the fields and approval trail built in and no signup. A request form is not FMLA certification: extended medical leave may require DOL Form WH-380. This is general information, not legal advice.

What a Leave Request Form Is

A leave request form is a document an employee fills out to request time off and that a supervisor or HR uses to approve or deny it. It captures the employee and department, the type of leave, the dates and total days, an optional reason, and signatures from both sides. Leave request form, time off request form, and PTO request form describe versions of the same document; the label shifts with the leave type, but the structure is the same.

It is a two-sided record: the employee section states the request, and the supervisor or HR section records the decision. Beyond granting time off, it does two jobs: it gives employees a predictable way to ask, and it gives the business a documented, even-handed approval trail. For extended medical or family leave, a plain form is only the starting point, because the Department of Labor FMLA forms may be required instead.

One Form, Two Signatures
A leave request form only works as a record when both sides sign it. The employee acknowledgment confirms the request and the details; the supervisor or HR approval records the decision. Skipping either turns a documented approval back into an informal, hard-to-prove conversation.

What to Include

A complete leave request form covers four groups: employee fields, leave details, context, and an approval trail. The groups below are the consensus set that strong leave forms share.

Employee fields
Name, ID, and department
Job title and manager
Contact during leave
Leave details
Type of leave
Start and end dates
Total days or hours requested
Context
Reason, where appropriate
Coverage or backup plan
Documentation, if required
Approval trail
Employee acknowledgment
Supervisor or HR approval
Signatures and dates

The two elements small businesses most often skip, and most need, are the signed employee acknowledgment and the supervisor approval line. The templates here build both in, and keep medical detail off the form so it can be stored separately.

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Which Template Should You Use?

Start with the general master form if you want one form for everything, or pick the specific version that matches the request. PTO for a consolidated plan, vacation for planned time, sick for illness, bereavement after a loss, unpaid for personal time beyond PTO, and leave of absence for extended leave.

General Leave Request Form
The universal master
One form with leave-type checkboxes for PTO, sick, personal, bereavement, unpaid, and more. The version to adapt when you want a single form that covers every request.
PTO / Time Off Request Form
Consolidated PTO plans
A paid time off form with a balance field, a paid or unpaid toggle, and remaining-balance math. For companies that run a single PTO bank instead of separate leave types.
Vacation Request Form
Planned time off
A vacation form with no required reason for privacy, plus a coverage and backup-contact field. For planned time off booked in advance.
Sick Leave Request Form
Illness and injury
A sick leave form with dates of absence, an optional doctor’s note checkbox, and a state paid-sick-leave reminder. Keeps medical detail off the form.
Bereavement Leave Request Form
After a loss
A compassionate bereavement form with a relationship field, a travel-required checkbox, and a policy day limit. For time off following the death of a loved one.
Unpaid / Personal Leave Form
Beyond available PTO
An unpaid or personal leave form with an explicit unpaid acknowledgment and an expected return date. For personal time beyond the PTO balance.
Leave of Absence Form (Extended)
FMLA-adjacent
An extended-leave form with continuous, intermittent, or reduced-schedule options and a built-in FMLA certification note pointing to DOL Form WH-380. For long medical or family leave.
Match the Form to the Request
One form for everything: the General master. Consolidated PTO plan: the PTO form. Planned time off: the Vacation form. Illness or injury: the Sick Leave form. After a loss: the Bereavement form. Personal time beyond PTO: the Unpaid form. Extended medical or family leave: the Leave of Absence form, which carries the FMLA note. Whichever you pick, keep the acknowledgment and approval lines and store medical detail separately.

7 Free Leave Request Form Templates

Download all seven as a single Word document or copy individual forms. The general form is the master; the others adapt it for a specific leave type. Fill in your company name, notice windows, and any policy limits, and keep the FMLA and confidentiality notes intact.

Download All 7 Leave Request Form Templates
General, PTO, vacation, sick, bereavement, unpaid, and leave of absence. All in one DOCX.

Template 1: General Employee Leave Request Form

The universal master with leave-type checkboxes, a coverage plan, and both acknowledgment and approval lines. The one form to adapt when you want a single request form for everything.

Employee Leave Request Form (General)
EMPLOYEE LEAVE REQUEST FORM
[Company Name]
[Address]

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Job title: __
Manager / Supervisor: __
Contact during leave: __

LEAVE DETAILS

Type of leave (check one):
[ ] PTO / Vacation [ ] Sick [ ] Personal [ ] Bereavement
[ ] Unpaid [ ] Jury duty [ ] Military [ ] Other: _
Start date: _ End date: _
Total days requested: _
[ ] Full days [ ] Partial (hours): _
Reason (optional): _____
_____

COVERAGE PLAN (OPTIONAL)

During my absence, [Coworker Name] will cover [responsibilities].
Main point of contact: __

EMPLOYEE ACKNOWLEDGMENT

I confirm this request is accurate and complies with company leave policy.
Employee signature: __ Date: _

SUPERVISOR / HR USE ONLY

[ ] Approved [ ] Denied
Comments: _____
Supervisor / HR signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice. Some leave is governed by the FMLA, the ADA, or state law; confirm your
obligations with a qualified professional before adopting this form.

Template 2: PTO / Time Off Request Form

A paid time off form with a balance field, a paid or unpaid toggle, and remaining-balance math. For companies running a single consolidated PTO bank.

PTO / Time Off Request Form
PTO / TIME OFF REQUEST FORM
[Company Name]
For companies with a consolidated paid time off (PTO) plan.

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Manager: __

PTO DETAILS

Type: [ ] Paid (PTO) [ ] Unpaid
Start date: _ End date: _
Total days requested: _
[ ] Full days [ ] Partial (hours): _
PTO balance available: _
Requested (this form): _
Remaining after approval: _

EMPLOYEE ACKNOWLEDGMENT

I confirm my PTO balance is sufficient for this request, subject to approval.
Employee signature: __ Date: _

SUPERVISOR / HR USE ONLY

[ ] Approved [ ] Denied
Comments: __
Supervisor signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice. Confirm your PTO and state paid-leave obligations with a professional.

Template 3: Vacation Request Form

A vacation form with no required reason for privacy, plus coverage and backup-contact fields. For planned time off booked in advance.

Vacation Request Form
VACATION REQUEST FORM
[Company Name]
For planned vacation time. No reason is required.

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Manager: __

VACATION DETAILS

Vacation start date: _ Return date: _
Total days requested: _
Contact during leave (optional): __
Backup coworker: __
Note: A reason is not required for a vacation request.

EMPLOYEE ACKNOWLEDGMENT

I confirm the dates above and that coverage has been arranged where needed.
Employee signature: __ Date: _

SUPERVISOR / HR USE ONLY

[ ] Approved [ ] Denied
Comments: __
Supervisor signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice.
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Template 4: Sick Leave Request Form

A sick leave form with dates of absence, an optional doctor's note checkbox, and a state paid-sick-leave reminder, kept free of diagnosis detail.

Sick Leave Request Form
SICK LEAVE REQUEST FORM
[Company Name]
For time off due to illness or injury.

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Manager: __

SICK LEAVE DETAILS

Date(s) of absence: __
Total days requested: _
[ ] Doctor's note attached
(may be required after [X] consecutive days per company policy)
Brief nature of absence (optional): __
Do not include diagnosis details. Keep any medical information confidential.

EMPLOYEE ACKNOWLEDGMENT

I confirm this request is accurate.
Employee signature: __ Date: _

SUPERVISOR / HR USE ONLY

[ ] Approved [ ] Denied
Comments: __
Supervisor signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice. Many states require paid sick leave; confirm the rule for the state
where the employee works, and keep medical information confidential.

Template 5: Bereavement Leave Request Form

A compassionate bereavement form with a relationship field, a travel-required checkbox, and a policy day limit. For time off after the death of a loved one.

Bereavement Leave Request Form
BEREAVEMENT LEAVE REQUEST FORM
[Company Name]
For time off following the death of a family member or loved one.

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Manager: __

BEREAVEMENT LEAVE DETAILS

Relationship to the deceased: __
Requested start date: _ Return date: _
Total days requested: _
(Company policy: up to [X] days of bereavement leave)
Travel required: [ ] Yes [ ] No

EMPLOYEE ACKNOWLEDGMENT

I confirm the dates above.
Employee signature: __ Date: _

SUPERVISOR / HR USE ONLY

[ ] Approved [ ] Denied
Comments: __
Supervisor signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice. Some states require bereavement leave; confirm your state rule.

Template 6: Unpaid / Personal Leave Request Form

An unpaid or personal leave form with an explicit unpaid acknowledgment and an expected return date. For personal time beyond the PTO balance.

Unpaid / Personal Leave Request Form
UNPAID / PERSONAL LEAVE REQUEST FORM
[Company Name]
For unpaid or personal time off beyond available PTO.

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Manager: __

LEAVE DETAILS

Reason (personal): __
Start date: _ Expected return date: _
Total days requested: _

EMPLOYEE ACKNOWLEDGMENT

I understand this leave is unpaid and is subject to approval. I understand my
return date is the expected date above and that benefits handling during unpaid
leave follows company policy.
Employee signature: __ Date: _

SUPERVISOR / OWNER USE ONLY

[ ] Approved [ ] Denied
Comments: __
Approver signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice. Unpaid leave may still trigger FMLA, ADA, or state obligations; confirm
with a professional before denying or approving extended leave.

Template 7: Leave of Absence Request Form

An extended-leave form with continuous, intermittent, or reduced-schedule options and a built-in FMLA certification note pointing to DOL Form WH-380. For long medical or family leave.

Leave of Absence Request Form (Extended)
LEAVE OF ABSENCE REQUEST FORM (EXTENDED)
[Company Name]
For an extended medical or family leave. Read the FMLA note carefully.

EMPLOYEE INFORMATION

Employee name: __ Employee ID: _
Department: __ Manager: __
Date of hire: _

LEAVE DETAILS

Type: [ ] Medical (own condition) [ ] Family care [ ] Other: ___
Schedule: [ ] Continuous [ ] Intermittent [ ] Reduced schedule
Start date: _ Expected return date: _
Estimated total duration: _
Medical certification:
[ ] To follow within 15 calendar days of the employer's request

FMLA NOTE (READ BEFORE SUBMITTING)

If this leave qualifies under the Family and Medical Leave Act (FMLA), your
employer may require a DOL medical certification: Form WH-380-E for your own
serious health condition, or Form WH-380-F for a family member's. The employer
must allow at least 15 calendar days to return the certification. FMLA applies
to covered employers (generally 50 or more employees) and eligible employees
(12 months of service, 1,250 hours, and 50 employees within 75 miles).

EMPLOYEE ACKNOWLEDGMENT

I confirm the information above and understand certification may be required.
Employee signature: __ Date: _

HR USE ONLY

[ ] Approved [ ] Denied [ ] Pending certification
FMLA-designated: [ ] Yes [ ] No [ ] Under review
Comments: __
HR signature: __ Date: _

DISCLAIMER: This is a sample form for general information only and is not legal
advice. Extended leave frequently involves the FMLA, the ADA, and state leave
laws; have a qualified employment professional review before acting.

Leave Request vs. FMLA and State Leave

A leave request form is your internal document; it is not the same as the federal FMLA process or a state paid-leave program, and knowing when a plain form is not enough is what separates a careful employer from a liable one. Here is how the three compare.

Leave request formFMLAState paid leave
What it isYour internal request formFederal job-protected leaveState-mandated paid leave
Who it applies toAny employer, any sizeCovered employers, 50+ employeesEmployers in that state
PaperworkThis formDOL WH-380, WH-381, WH-382State portal or claim
PayPer your policyUnpaid, job-protectedPaid per state rule
Can you deny it?Discretionary leave, yesGenerally no, if eligibleGenerally no, if eligible

The rule of thumb: use your leave request form for ordinary time off, and recognize when a request crosses into protected territory. When extended medical or family leave may qualify under the FMLA, the leave of absence form points the employee to the DOL FMLA eligibility rules and the certification forms. For the classification questions underneath leave decisions, the FMLA guide covers the details.

Compliance Notes

Four federal and state points sit underneath any leave form. None is complicated, but each is a place a small business can quietly create liability. Handle these four and a simple form stays defensible.

FMLA: a leave request form is not FMLA certification
The Family and Medical Leave Act gives eligible employees up to 12 weeks of job-protected leave, but it applies only to covered employers, generally those with 50 or more employees in 20 or more workweeks. An employee is eligible after 12 months of service, 1,250 hours worked in the prior year, and working at a site with at least 50 employees within 75 miles. When leave may qualify under the FMLA, a plain request form is not enough: the employer may require a DOL medical certification, Form WH-380-E for the employee’s own serious health condition or WH-380-F for a family member’s, and must allow at least 15 calendar days to return it. Use the leave of absence form for these cases and point the employee to the DOL forms. This is general information, not legal advice.
GINA: do not ask for family medical history
The Genetic Information Nondiscrimination Act (GINA) applies to employers with 15 or more employees and restricts asking for or using genetic information, which includes family medical history. The practical risk on a leave or sick form is asking a question broad enough to pull in that information. The EEOC provides safe-harbor language: when you request medical documentation to support a leave, tell the provider in writing not to include genetic information or family medical history. Keep sick and medical leave forms focused on dates and fitness for duty, not diagnosis, and add the safe-harbor notice when you request supporting documentation. This is general information, not legal advice.
State paid sick leave: an approval you may not be able to withhold
There is no federal paid-sick-leave mandate, but a growing number of states and cities require it, and the rules differ on accrual, permitted uses, and documentation. In a state with a paid-sick-leave law, protected sick time generally cannot be treated as an ordinary discretionary absence, and asking for a doctor’s note too early can itself violate the law. Because these laws change often and apply based on where the employee actually works, including remote employees, identify the rule for every state where you have staff and re-check it periodically rather than assuming last year’s list still holds. This is general information, not legal advice.
Confidentiality: leave records are not general personnel records
Medical information tied to a leave request, doctor’s notes, certifications, and anything describing a condition, must be kept confidential and stored separately from the regular personnel file, and access limited to those who need it. This is both an ADA requirement for medical information and simple good practice. A leave request form itself is fine in the personnel file, but the medical backup behind it belongs in a separate, restricted file. Design your forms so the request and the medical documentation are separable, and store the medical piece apart from the rest. This is general information, not legal advice.
FMLA Coverage Thresholds (DOL, Fact Sheet #28)
The FMLA covers private employers with 50 or more employees in 20 or more workweeks. An employee is eligible after 12 months of service, 1,250 hours in the prior year, and working where the employer has 50 employees within 75 miles (U.S. DOL). Most small businesses fall below this, but state leave laws still apply. This is general information, not legal advice.

For the policy that sits behind these forms, the leave of absence policy templates cover eligibility, notice, and the FMLA and ADA interaction in depth, with the same confidentiality guardrails.

Handling Leave at a Small Business

A large company routes leave through an HR team and a leave-management system. A small business has an owner or a manager fielding requests directly, between everything else, and feels each absence more sharply because there is no bench. The good news is that the process is the same at any size; a small business just needs it simple, consistent, and documented.

Keep It Simple, but Keep the Guardrails
A small team does not need a complex leave system. A consistent form, a clear notice window, an even-handed approval habit, and a signed record cover most of it. The parts you cannot simplify away are the compliance guardrails: check whether a request is protected before denying it, keep medical detail off the form and stored separately, and add the GINA safe-harbor notice when you request documentation. Start simple, but keep the guardrails. This is general information, not legal advice.

The single most valuable habit is using the same form for every request and collecting a signed approval each time. A consistent, signed, retained record is what turns a leave question into a quick lookup instead of an argument, and what protects an even-handed decision if one is ever challenged.

From Request to Approved and Stored

A leave request form delivers its value when it is filled in consistently, approved with a signature, and stored where you can find it, with the medical piece kept separate. That means picking the right form, collecting the signatures, checking compliance, and filing the record.

Pick the form
Choose the form that fits the request, set your notice window and any policy limits, and keep the FMLA and confidentiality notes intact.
Collect and e-sign
The employee fills in and signs the form; the supervisor or owner approves. E-signature turns it into an approved, dated record.
Check compliance
Before approving extended or medical leave, confirm whether the FMLA, ADA, or a state law applies, and request certification the right way.
Store the record
File the approved request, keeping any medical documentation separate and confidential, and retain it for your recordkeeping period.

The templates above work on their own. To run leave without a paper tray, FirstHR captures the request and approval with e-signature, the same flow it uses for the employee handbook, stores the approved form on the employee record, and keeps medical documentation in a separate, access-controlled place. FirstHR is an onboarding and HR platform, not a payroll or leave-accrual engine: it does not calculate PTO balances, run payroll, or determine FMLA eligibility for you, so pair it with your payroll and leave providers and, for protected-leave questions, a professional advisor. Applicant tracking is coming soon to FirstHR.

Key Takeaways
A leave request form is a two-sided record: the employee requests time off and the supervisor or HR approves it, each with a signature.
Use the general master form for everything, or the specific version for PTO, vacation, sick, bereavement, unpaid, or extended leave.
A request form is not FMLA certification; extended medical leave may require DOL Form WH-380-E or WH-380-F.
Most small businesses fall below the FMLA 50-employee threshold, but state paid-sick-leave and ADA obligations still apply.
Keep medical detail off the form, add the GINA safe-harbor notice when requesting documentation, and store medical records separately.
Apply your leave policy evenly and keep a signed record; consistency is the real defense in a disputed decision. This is general information, not legal advice.

Frequently Asked Questions

What is an employee leave request form?

An employee leave request form is a document an employee fills out to formally request time off, and that a supervisor or HR uses to approve or deny it. A typical form captures the employee name and department, the type of leave, the start and end dates, the total days requested, an optional reason, and space for the employee to acknowledge and the approver to sign. It creates a clear, consistent record of who asked for what, when, and whether it was granted. Leave request forms come in general versions that cover every leave type with checkboxes, and specific versions for PTO, vacation, sick, bereavement, unpaid, and extended leave. The form does two jobs: it gives employees a predictable way to ask for time off, and it gives the business a documented, even-handed approval trail that supports fair decisions and clean records.

What should a leave request form include?

A complete leave request form includes employee fields, leave details, any needed context, and an approval trail. The employee fields are the name, ID, department, job title, and manager, plus a contact during leave. The leave details are the type of leave, the start and end dates, and the total days or hours requested. The context is a reason where appropriate, a coverage or backup plan, and documentation such as a doctor’s note if your policy requires one. The approval trail is the employee acknowledgment and the supervisor or HR approval, each with a signature and date. The two elements small businesses most often skip, and most need, are the signed employee acknowledgment and the supervisor approval line, because together they turn an informal ask into a dated, defensible record. Keep medical detail off the form and store it separately.

What is the difference between a leave request form and FMLA paperwork?

A leave request form is your internal document for any time-off request; FMLA paperwork is a specific set of federal forms used when leave qualifies under the Family and Medical Leave Act. Your leave request form collects the basics and routes the request for approval. When leave may be FMLA-qualifying, that internal form is not enough. The employer may require a DOL medical certification, Form WH-380-E for the employee’s own serious health condition or WH-380-F for a family member’s, and provides eligibility and designation notices (WH-381 and WH-382). The FMLA applies only to covered employers, generally those with 50 or more employees, and eligible employees. So a small business under 50 employees usually is not covered by the FMLA, but may still face state leave laws. Use the leave request form for ordinary requests and the DOL forms when the FMLA applies. This is general information, not legal advice.

Does a small business need a leave request form?

Yes, even a very small business benefits from one. A written form replaces scattered texts and hallway conversations with a single, consistent record of every request and decision. That matters for three reasons: it helps you apply your leave policy evenly, which is your best defense against a claim of unfair treatment; it creates the documentation you need if a request is ever disputed; and it makes coverage planning easier because requests arrive in a predictable format. A small business is not usually covered by the FMLA, which generally applies at 50 or more employees, but it is still subject to state paid-sick-leave laws, the ADA for medical accommodations, and basic recordkeeping expectations. A simple, consistent leave request form is the low-effort way to stay organized and even-handed. This is general information, not legal advice.

Can an employer deny a leave request?

It depends on the type of leave. Discretionary leave, such as vacation or personal time beyond any policy entitlement, can generally be approved or denied based on business needs, as long as the decision is applied consistently and not for a discriminatory reason. Protected leave is different. Leave protected by the FMLA, a state paid-sick-leave law, or as an ADA accommodation generally cannot be denied simply because it is inconvenient, and mishandling it can create liability. The safe approach is to check whether a request is protected before denying it: if it might qualify under the FMLA, a state law, or the ADA, pause and confirm eligibility rather than issuing an automatic denial. For ordinary discretionary requests, apply your policy evenly and document the reason. This is general information, not legal advice.

How much notice should an employee give for a leave request?

Notice expectations depend on the leave type and are set by your policy, within legal limits. For planned leave like vacation, a common expectation is two to four weeks of notice, enough to arrange coverage. For foreseeable FMLA leave, the law expects the employee to give about 30 days of notice when practical. For unforeseeable leave, such as a sudden illness or emergency, the employee should give notice as soon as practicable, and you cannot require advance notice that is impossible to give. Sick leave and protected leave often cannot carry the same strict notice requirements as vacation. State the notice windows for each leave type clearly in your policy and on the form, but build in the reality that genuine emergencies will not follow the schedule. This is general information, not legal advice.

How should I store a completed leave request form?

Store the approved request as part of your employment records, but keep any medical information separate. A completed leave request form generally belongs in the employee’s personnel file, but doctor’s notes, medical certifications, and anything describing a health condition must be kept confidential and stored in a separate medical file with restricted access, which is an ADA requirement. Retain the records for your applicable recordkeeping period; leave and payroll-related records are commonly kept for at least three years, and some states require longer. The practical setup is simple: file the request itself with the employee’s records, file the medical backup separately and securely, and make sure both are retrievable if a question or audit arises. This is general information, not legal advice.

Is a bereavement or sick leave request required by law?

It varies by state. There is no federal requirement for paid bereavement leave or, in most cases, paid sick leave, but a growing number of states and cities require paid sick leave, and a smaller number require bereavement leave. Where a law applies, you generally cannot treat protected time as an ordinary discretionary absence or discipline an employee for using it, and documentation rules may be limited. Because these laws apply based on where the employee actually works, including remote employees, and change frequently, identify the requirements for every state where you have staff and re-check them periodically. Absent a state mandate, bereavement and sick leave are set by your own policy, which the forms on this page help you apply consistently. This is general information, not legal advice.

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