Employee Leave of Absence

Please complete the form below. Required fields marked with an asterisk *

Employee Leave of Absence

Please complete this form and submit to Human Resources.

A staff member will review the application and respond within 24-48 hours.

Employee Last Name*

Answer required for "Employee Last Name"

Employee First Name*

Answer required for "Employee First Name"

Employee Email*

Answer required for "Employee Email"

Employee Position*

Answer required for "Employee Position"

Requested Leave Start Date*

Answer required for "Requested Leave Start Date"

Expected Return Date*

Answer required for "Expected Return Date"

Brief explanation of why you need a leave of absence if unsure what type of leave you need:

Answer required for "Brief explanation of why you need a leave of absence if unsure what type of leave you need:"

Please upload any documents required for your leave request (see above)

Answer required for "Please upload any documents required for your leave request (see above)"

Choose a file or drag it here.

After your leave request is received, HR will determine what is required to approve your leave. Sick days, personal days, vacation days, FMLA, NJ FLA, and/or NJFLI will be considered when processing your leave.

HR will review your attendance and send you your options. Once processed, your leave information will be sent to you to review before finalized. Please check off which options you would choose if applicable (below).

**Sick Days cannot be used to care for a Family Member. This would be unpaid leave.**

Leave Options*

Answer required for "Leave Options"

Yes, I would like to use sick time

Yes, I would like to use vacation time

Yes, I would like to use personal time

I understand that it is MPS procedure to leave my laptop during a Leave of Absence that is more than 10 days.*

Answer required for "I understand that it is MPS procedure to leave my laptop during a Leave of Absence that is more than 10 days."

I understand.

Please fix the highlighted areas below before submitting.

Employee Leave of Absence

Employee Leave of Absence