Leave of Absence Request Form

Leave of Absence Request Form  

As outlined in David Christopher’s Employee Handbook, a leave of absence is available in certain circumstances and up to 30 days. Since we are a small organization, extended leaves may not be approved, and your position may have to be filled before you able to return to work.  Each leave request is viewed on a case by case basis based on the person’s position and the season in which your leave takes place. You may use any available leave time you have accumulated if your request is approved. You may view your available leave time on your paystub. Employees who meet the eligibility criteria for a leave of absence must complete this form at least 30 days prior to the commencement of leave or as soon as practicable in the event of an unforeseeable absence. Please note:  

  • All leaves of absence must be approved in advance by human resources and the employee’s supervisor. Only full-time, permanent employees may request a leave of absence.  
  • If the dates of requested leave time change, a new leave of absence request form must be submitted for approval.  
  • If you have leave time in your leave account, you will need to complete the Request To Be Paid for Leave Time form in order to be paid for that time.  
  • Employees on an unpaid leave of absence are responsible for payment of insurance premiums as agreed upon with human resources prior to commencement of leave. If the employee has insurance through the Company and plans to be out longer than one week, the employee will have to shop individual health plans. Blue Cross Blue Shield requires the employee work 30 hours per week in order to be eligible for benefits. Human resources is legally responsible for reporting this information to Blue Cross Blue Shield.  
  • Employees returning from a leave of absence must contact human resources at least one week in advance of the projected return date.  
  • David Christopher’s does not meet the criteria in order to offer the Family and Medical Leave Act (FMLA). Jobs are not guaranteed to be held during an extended leave of absence. If a hardship on the company and/or its employees during the leave of absence, the vacant position may have to be filled.  

 

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