Leave of Absence Request Letter [FREE Sample]

Here is a sample leave of absence request letter. It can be tailored to whatever the need.

Leave Of Absence request letter sample


Wolverine Supplies
89 Kendall Street
Vargas, ND 74569

Dear Mr. Jayson,

As we discussed yesterday, I would like to request a formal leave of absence from my job. I have been having health problems. Though many methods have been explored for how to correct the problem, surgery is inevitable.

The reconstructive surgery on my knee will require a lengthy absence from work. I am so sorry that I have to do this to you, but I am going to have to take the full 12 weeks allowed with FMLA.

My doctor has filled out the request form, which I got from HR. I have attached this to this letter to begin the process.

In an effort to be fair to a company that I enjoy working for, I am allowing you a month’s notice to make other arrangements for my position.

My surgery is scheduled for [DATE]. I can work until [DATE], to ensure that there is adequate coverage.

If you need me to train anyone to cover my position, or to wrap up some business matters, I would be more than willing. I anticipate that my return will be [DATE].

While this is just an estimate, I want you to be prepared. I hope to return before this time and to retain my rightful position.

I appreciate your consideration in this matter. You have always been great to work for through the years and I know you will understand that this is something that must be done. If you have any questions, please feel free to let me know.


Tatum G. Clark