This Absence Request Report is for use by an employee who is requesting a leave of absence from work. This simple to use form contains the employee's name, type of absence requested (i.e., vacation, jury duty, bereavement) and the dates of absence. It also contains a reason for absence in which the employee can briefly explain why the leave is requested. This Absence Request Report serves as a written record of an employee's absence and will prove helpful if there are future questions or concerns. This Absence Request Report contains the following: Employee: The employee's name, employee number, department and manager; Dates/Reason: Sets out the specific dates the employee will be absent and a brief explanation of the reason; Employer Notes: Sets out any comments the employer has in regard to the employee's absence. Protect your rights by using our attorney-prepared forms. This attorney-prepared packet contains: General Instructions Absence Request Report State Law Compliance: This form complies with the laws of all states