Sick Leave Letter to Manager Sample

Here is a sample sick leave letter. It should be sent by certified mail, so the sender has proof of the time and date it was received. This could be important if there is any legal question pertaining to the proper method of requesting the leave. 

The sender should keep a copy of all communications about the leave application, and any medical letters or documents included should be copies and not original documents. 

Sick Leave letter to Manager Sample

Applicant’s Name
Applicant’s Address
City, State, Zip Code


Employer’s Name
Employer’s Position
Company or Institution’s Name
Employer’s Address
City, State, Zip Code

Dear Employer’s Name, 

This letter is accompanying my medical leave form to inform you that I am requesting medical leave for three weeks from DATE to DATE. I will resume work on DATE. I have injured my back in an automobile accident and have been requested by my doctor to take a three-week treatment. Enclosed is a copy of her instructions. 

I understand that you will employ a substitute teacher to take my sixth grade class for the three weeks, and I have prepared the lessons plans that cover the classwork and extracurricular activities. I have also included a short description of each student to help the substitute get to know the children.

I have completed the medical leave form required by the school, and according to my contract, I am allowed to take emergency medical leave. 

You or the substitute can reach me at 555-123-4567 or a if there are any questions of if they require any help I can give. 

Thank you for your kind consideration of my request.


Signature of Employee
Printed Name of Employee
List of Enclosures
Copy to superintendent or principal as applicable