This Leave of Absence Request Form shall be used to request time off from work whether you are requesting leave to be paid or unpaid, for all reasons except for work related injuries. For work related injuries please refer to San Mateo County’s Workers’ Compensation Benefits Package which you may obtain from your payroll specialist or Risk Management.

As an owner of a business or an employee, you must know how a leave of absence form works and, more importantly, what should be included on the form. These forms allow you to take time away from work that is outside of a vacation or sick leave. In fact, your absence will be considered an unusual circumstance wherein approval must be given.
What is Included
You can create a free leave of absence
- Reason for Leave: The reason for the employee’s leave must be listed on the form.
- Duration: The commencement and the end of the leave granted. This will include the exact dates of leaving and returning to work.
- Compensation: Employees may or may not be compensated during their absence. Unpaid leaves are quite common, but this is at the discretion of the employer. At this time, you may also retain your health coverage in some cases.