Request Letter for Leave of Absence USA Template
On this page you will find a request letter for leave of absence template (USA) ready for direct editing and download in Word and PDF format for free, with a guide on your rights under the FMLA.
| Country | 🇺🇸 United States |
|---|---|
| Document Type | Employment |
| Format | Word, PDF & direct fill |
| Cost | Free |
| Fill Time | About 10 minutes |
| Notarization | Required |
What Is This Template and When to Use It?
A request letter for leave of absence is a formal written request to your employer for time away from work. It can be for medical reasons, family care, personal reasons, education, or military service. Under the Family and Medical Leave Act (FMLA), eligible employees are entitled to up to 12 weeks of unpaid, job-protected leave per year for qualifying reasons. Many states also have their own leave laws with additional protections.
Where to Submit
Submit to your direct supervisor and HR department. Give as much notice as possible — FMLA requires 30 days' advance notice when the leave is foreseeable. For unforeseeable leave, notify your employer as soon as practicable. Keep a copy for your records.
Does It Require Notarization?
Required. Not required. Sign and date the letter.
Documents You Need
- Company leave of absence policy (check employee handbook)
- FMLA eligibility verification (12 months of employment, 1,250 hours worked)
- Medical certification (FMLA Form WH-380-E for employee, WH-380-F for family)
- Plan for work coverage during your absence
- HR contact information
How to Use This Template
- Click any yellow field inside the template and type your information (press Enter to move to the next field).
- Review the text; you can edit any sentence by clicking the "Edit" button.
- Click "Word" or "PDF" or "Copy", then sign the letter.
Ready-to-Fill Template: Leave of Absence Request
Your Full Name
Your Job Title
Department
Employee ID (if applicable)
Date
Supervisor's Name
Supervisor's Title
Company Name
Company Address
RE: Request for Leave of Absence
Dear Supervisor's Name,
I am writing to formally request a leave of absence from my position as Your Job Title in the Department department.
Leave Details:
Type of Leave: FMLA / Medical / Personal / Family / Military / Educational
Start Date: Requested Start Date
Expected Return Date: Expected Return Date
Duration: Number of weeks/months
Reason for Leave:
Briefly describe the reason: medical condition requiring treatment, care for a family member with a serious health condition, birth/adoption of a child, personal reasons, etc. You do not need to disclose specific medical diagnoses.
Work Coverage Plan:
Describe how your duties will be covered: delegated to [colleague name], projects completed before leave, available by email for urgent questions, etc.
I understand that this leave may be paid / unpaid / partially paid in accordance with company policy. I would like to use accrued PTO / vacation time / request unpaid leave during this period.
I am committed to ensuring a smooth transition before my departure and will complete all pending work by date. I look forward to returning to my role on return date.
Please let me know if you need any additional information or documentation.
Sincerely,
Your Signature
Your Full Name (printed)
⚠️ Disclaimer: This template is for informational purposes only and does not constitute legal advice. Always verify the requirements with the relevant authority before submitting.
Sources & References
- US Department of Labor - Family and Medical Leave Act (dol.gov/agencies/whd/fmla)
- FMLA Forms (WH-380-E, WH-380-F, WH-381)
- State Family and Medical Leave Laws
Always check the latest requirements before submitting.
- Employment Verification Letter Template USA 2026
- Formal Grievance Letter Workplace USA Template
Common Mistakes to Avoid
- ❌ Not giving enough advance notice (FMLA requires 30 days for foreseeable leave).
- ❌ Failing to submit required medical certification on time.
- ❌ Not checking your company's specific leave policy in addition to FMLA.
- ❌ Assuming your leave is automatically approved — always get written confirmation.
- ❌ Not making a plan for work coverage during your absence.
Important Tips Before Submitting
- • Submit your request in writing even if you've discussed it verbally.
- • Keep a copy of your letter and any HR correspondence about the leave.
- • If your leave is FMLA-qualifying, submit medical certification within 15 days of your employer's request.
- • Check your state's family and medical leave laws — many states offer additional protections beyond FMLA.
- • Continue to pay your share of health insurance premiums during unpaid leave to maintain coverage.
Frequently Asked Questions
Am I eligible for FMLA leave?
To be eligible for FMLA, you must: work for a covered employer (50+ employees within 75 miles), have worked for the employer for at least 12 months, and have worked at least 1,250 hours in the 12 months before your leave starts.
Can my employer deny my leave of absence request?
Your employer cannot deny FMLA leave if you are eligible and have a qualifying reason. However, they can deny non-FMLA leave requests. Even with FMLA, they can require medical certification and may deny leave if you don't provide it.
Will I still have my job when I return from FMLA leave?
Under FMLA, your employer must restore you to the same or an equivalent position when you return. However, you would have been subject to the same employment actions (layoffs, etc.) even without the leave. Key employees (top 10% salaried) may have limited reinstatement rights.