EMPLOYEE ASSISTANCE REQUEST SLIP
[Company Name] is committed to providing a supportive work environment, and our Employee Assistance Program (EAP) is designed to offer various kinds of professional support and services to our employees. If you need assistance, whether it be mental health support, financial counseling, legal consultation, or any other kind of help, please complete this Employee Assistance Request Slip.
Fill in all the fields: Provide your name, employee ID, department, contact information, and the type of assistance you require.
Date and Sign: Sign the request slip and put today's date.
Submit to HR: Once completed, please submit this slip to the HR department either in person or via email.
Wait for Confirmation: After submission, the HR department will process your request and schedule an appointment for you, which you will be informed of.
All information provided will be kept confidential to the extent permissible by law. Thank you for using [Company Name]'s Employee Assistance Program.
Request Slip For: Employee Assistance Program
Field | Information |
Employee Name: | |
Employee ID: | |
Department: | |
Contact Number: | |
Email Address: | |
Date of Request: | |
Type of Assistance Required: | |
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Preferred Date for Assistance: | |
Preferred Time for Assistance: | |
Brief Description of the Issue: | |
Employee Signature: | |
Date: | |
For HR Department Use Only:
Field | Information |
Received By: | |
Date Received: | |
Scheduled Appointment With: | |
Date of Appointment: | |
For any queries or concerns, please contact the HR department at [Company Phone Number] or [Company Email].
Employee Acknowledgment:
Date:
Keep a copy of this form for your records and submit the original to the HR Department.
Thank you for using [Company Name]'s Employee Assistance Program. We are here to support you.
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