Employee request to extend an existing approved leave of absence beyond the original end date. Captures the original leave type, reason for extension, new proposed end date, and updated benefit and return-to-work arrangements.
The Leave of Absence Extension Request is a ready-to-use employment & hr template you can send for signature in minutes. It is written for 1 signer (employee) and, by default, expires 30 days after it is sent if left unsigned. It covers leave extension, leave of absence, fmla, hr, employment, extension. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Leave of Absence Extension Request This form is used to request an extension of a previously approved leave of absence. It is submitted to Human Resources and the employee's direct manager for review before the original leave end date. --- ## Part A — Employee Information **Full Legal Name:** ___________ **Employee ID / Personnel Number:** ___________ **Department:** ___________ **Job Title:** ___________ **Manager / Supervisor Name:** ___________ **Work Email:** ___________ **Personal Phone:** ___________ --- ## Part B — Original Leave Details **Type of Original Leave:** ___________ **Original Leave Start Date:** ___________ **Original Leave Approved End Date:** ___________ **Was the original leave approved in writing by HR?** ___________ **HR Contact or Case Manager for Original Leave (if known):** ___________