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Formal Leave of Absence Letter Example: A Template to Adapt

A practical leave-of-absence letter template with guidance on dates, privacy, workplace procedures, and U.S. FMLA notice and certification.
From TheFinanceBase Team3 min to read
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Use this formal leave of absence letter example as a starting point: state the dates you expect to be away, give a brief appropriate reason, and ask your manager or HR which policy, forms, and notice procedures apply. The right wording and paperwork depend on your employer, the kind of leave, and where you work.

Formal leave of absence letter example

Subject: Request for leave of absence

Dear [Manager or HR representative],

I am requesting a leave of absence from [start date] through [anticipated end date] because of [brief, appropriate reason, such as a medical or family-care need]. At this time, I expect to return on [date]. [If applicable: I may need intermittent leave or a modified schedule; I will share the expected schedule when available.]

Please let me know which leave policy applies, what forms or documentation I should submit, and whether you need any additional information. I will follow the applicable notice and call-in procedures and will update you if my expected dates change.

Thank you,
[Name]
[Job title or department]
[Contact information]

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Before sending, replace the bracketed text, confirm the recipient and required delivery method, include only the personal detail needed to explain the request, and keep a copy. This writing example is not a substitute for your employer’s forms or a determination of legal eligibility.

How to adapt the letter to your situation

Choose dates and describe uncertainty

Include the first day you expect to be away and your anticipated return date. If you cannot yet give an exact end date, say that it is an estimate and ask how and when your employer wants updates. For intermittent leave or a modified schedule, mention that possibility and provide a schedule when you can.

Give a brief, appropriate reason

Identify the general basis for the request, such as a medical need, family caregiving, parental leave, or personal leave. Avoid adding unnecessary private or medical details to a general request letter. Ask HR what supporting information is required rather than assuming the letter must contain it.

Use the employer’s request process

Check your workplace leave policy and usual request procedure before sending the letter. Confirm whether it should go to a manager, HR, or both, and whether you must also use a portal, call-in line, or separate form. A letter can document your request, but it may not replace those steps.

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U.S. FMLA example: notice and forms

The Family and Medical Leave Act (FMLA) rules below apply in the United States and only when the law covers the employer, the employee is eligible, and the reason qualifies. State or local laws and employer policies may also apply. The U.S. Department of Labor’s March 2025 Fact Sheet #28E says employees should follow their employer’s usual and customary workplace procedures for requesting leave unless unusual circumstances prevent it.

What to say and when to give notice

For a first request based on a potentially FMLA-qualifying reason, an employee does not have to use the words “FMLA.” They do need to share enough information for the employer to recognize that the leave may qualify. For foreseeable leave, give at least 30 days’ advance notice when that is possible and practicable. If the need arises less than 30 days ahead or is unforeseeable, notify the employer as soon as possible and practical; for unexpected leave, do so as soon as circumstances permit.

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Certification is separate from the request letter

A request letter does not by itself establish FMLA eligibility, meet every certification requirement, or guarantee approval. When health-care-provider certification applies, the Department of Labor lists forms including WH-380-E for an employee’s own serious health condition and WH-380-F for a family member’s serious health condition. Ask HR which form and submission process apply to your request.

Federal civilian employees have separate details

For most covered federal civilian employees, the Office of Personnel Management describes an entitlement of up to 12 workweeks of unpaid leave during a 12-month period for qualifying reasons. Those are federal-specific rules, not a general description of FMLA rights for every worker; consult OPM’s FMLA 12-week entitlement fact sheet for that context.

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