Leave Request Form

Employee Information
Name:	[YOUR NAME]
Department:	[YOUR DEPARTMENT]
Position Title:	[YOUR POSITION]
Leave Details
Type of Leave:	[YOUR LEAVE TYPE]
Start Date:	[YOUR START DATE]
End Date:	[YOUR END DATE]
Reason for Leave:
[YOUR REASON]

I, [YOUR NAME], hereby acknowledge that the information given above is correct to my knowledge and that I understand the terms of the company leave policy. I accept any consequences that may result from the information provided being incorrect.

Employee Signature:
Date:

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