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Extended Leave Request*
*For use when an employee will be on leave 3 weeks or more
Email address of manager requesting change:
*
Leave Request is for
*
*
Home location for employee:
*
*Please contact HR for potential benefits that may be paused during this extended leave period.
Leave start date:
*
Leave end date:
*
Type of extended leave:
*
A
Military
B
Medical
C
Maternity/Paternity
D
Other
Please upload a copy of the employee's email request for leave:
*
Click to choose a file or drag here
Size limit: 100 MB
Submit