Status Update and Request Form

Name *
Date Leaving Work *
Date Leaving Work
Date Returning to Work *
Date Returning to Work
If you selected Leave & Return, Late Arrival, or Early Leave in the type box, please state those times below.
Acknowledgement *
I am expected to provide documentation to the Company's HR manager, whenever possible, concerning the reasons for any absences from or tardiness to work, and I must also complete all company forms required due to missing work for personal or family medical or health issues, visits to a medical or dental facility or provider, funerals, jury duty, personal business, court appearances, or any other reasons. I further understand that this documentation must be provided no later the second business day following the date(s) I missed or was tardy.