Funeral Leave Request Form

Funeral Leave Request Form

Employee Name: _________________________

Date(s) Requested: __________________

I request funeral leave for ________ hours funeral leave in connection with the death of my __________________________* (specify relationship of close relative). The funeral will be/was held on __________________ in _________________________ (city & state). I am requesting more than one day because of the following unusual circumstances:

_________________________________	_____________________________
Employee Signature	Date
Supervisor: I approve ________ hours funeral leave for the above named employee. The request is for the death of a "close relative" (spouse, parent, grandparent, sister, brother or child, including in-laws, and relatives living in the same household with the employee) and the leave requested is appropriate for these circumstances.
_________________________________	_____________________________
Supervisor's Signature	Date