Unpaid leave of absence letter sample (3+ samples)

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In this brief guide, we will take a look at some sample unpaid leave of absence letters.

unpaid leave of absence letter sample 

“ You [will/will not] be required to use any accrued paid leave prior to taking unpaid leave.

[Company Name] will continue to pay its portion of the cost of your benefits, including health, dental, life and disability insurance benefits, while you are on this leave of absence. You must continue to pay your portion of the benefits, which may be made by payroll deductions (when applicable) or by check or money order submitted to the HR department each pay period. [Set forth dates, e.g., the 10th of each month or the pay periods that specifically cover the agreement with the employee.] If you fail to pay your portion of the benefits for more than 30 days, you and your beneficiaries’ coverage(s) will be terminated, and you will be offered COBRA to continue benefits, excluding life and disability insurance.

Benefits such as vacation, sick, personal days and holidays will not accrue while you are on a leave of absence.

While on leave, you [will/will not] be required to furnish us with periodic reports every [indicate interval of periodic reports, as appropriate for the particular leave situation] of your status and intent to return to work. If the circumstances of your leave change and you are able to return to work earlier than the date indicated, you [will/will not] be required to notify us at least three work days prior to the date you intend to report to work. 

If you are unable to return by the end of your leave, you must request an extension of the leave, in writing, five days prior to the leave expiration date. If [Company Name] does not extend the leave, you must return to work on the originally scheduled return date or be considered to have voluntarily resigned from your position. Extensions of leave will only be considered on a case-by-case basis.

If you are on a leave of absence due to medical reasons, you must submit a physician’s statement releasing you back to work on or prior to your date of return. 

Upon the expiration of the leave, you may be returned to your former position, if available. If the position is not available, you may be offered another available position for which you are qualified. If no position is available when you are able to return to work, you will be terminated and may apply for the next available position. 

Failure to return to work upon the expiration of the leave of absence or refusing an offer of reinstatement for which you are qualified will be considered a voluntary resignation of employment.

If you have any questions, please contact me at [phone number].

Sincerely,

[HR Representative’s name and signature]

  “

unpaid leave of absence letter sample : Sample 2

“ Your Name

Your Address

Your City, State Zip Code

Your Phone Number

Date

Supervisor’s Name

Title

Organization

Address

City, State Zip Code

Dear Mr./Ms. [Last Name]:

This letter is a formal request for a leave of absence, to follow up on our meeting yesterday. As we discussed, I would like to request a leave of absence from August 31, 2021, through October 30, 2021.

I will return to work on November 2, 2021.

Please let me know whether you require any further information or have any questions.

Thank you very much for your consideration in affording me this opportunity for personal leave.

Sincerely,

Your Signature (hard copy letter)

Your Typed Name  “

unpaid leave of absence letter sample : Sample 3

“  Subject: Leave of Absence – John Dooley

Dear Jennifer,

As we discussed yesterday, I would like to request a formal leave of absence from my job. I plan to be away from August 31, 2021 to October 30, 2021, returning to work on November 2, 2021.

If approved, I would be glad to help with a plan to cover my workload in my absence. I would also be available to answer questions and provide assistance while I am away.

Please let me know whether you require any additional information. Thank you very much for your consideration of my request.

Best,

John   “

unpaid leave of absence letter sample : Sample 4

“ Hannah Ferrari

16 Crossberry Lane

Declan, MI 12345

November 15, 2021

George Nguen

Human Resources Manager

ABC Company

111 Broadway

Sanders, MI 12346

Dear Mr. Nguen,

I would like to formally request a two-month leave of absence for personal reasons. If possible, I would like the leave from work to begin on December 1, 2021, with a return date of February 1, 2022.

If approved, I will be staying with family in Lansing during this time period, and I would be glad to assist with any questions via email or phone whenever possible.

Thank you very much for your consideration.

Sincerely,

Signature (hard copy letter)

Hannah Ferrari   “

unpaid leave of absence letter sample : Sample 5

“ Subject: Leave of Absence Request—Michaela Fox

Dear John,

As we discussed, I am requesting a personal leave of absence from work for family reasons from January 15, 2021 through February 28, 2022.

If approved, I will return to the office on March 1, 2022. I’d be glad to assist with planning for covering my responsibilities when I am away.

Thank you very much for your consideration.

Best,

Michaela   “

unpaid leave of absence letter sample : Sample 6

“  Dear [Manager Name],

I would like to ask for your approval to take unpaid leave from [start date] to [end date] due to [reason or private matter]. I apologize for the short notice but this is an emergency situation and is totally unplanned.

The workflow will not be interrupted as John is willing to cover for me during that period.

Thank you very much for understanding.

Best Regards   “

Conclusion

In this brief guide, we will take a look at some sample unpaid leave of absence sample letter. 

Please feel free to reach out with any questions or comments you may have.

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