Sick Leave Request
A sick leave request tells a workplace you were out or will be out because you were ill, and which days payroll should mark. It is not a doctor's note. If the handbook requires a note after a certain number of days, attach the note the clinic gives you. You do not need to write a diagnosis on this page. "I was ill" is enough unless a specific law or policy requires more. Do not use this form to request long medical leave. Ask HR about the legally required leave process.
For an employee reporting sick time. When: as soon as you can, including the day you return if you could not write sooner.
Naming a state changes the note on the page. It does not add that state's required clauses, fees, or font rules. Papero does not invent statutes.
6 lines are still blank. You can still print. Write "not applicable" on a line that does not apply.
Leaving this page clears what you typed. Papero does not save it. On a shared computer, press Clear before you walk away.
Preview. This is the page that prints.
Sick Leave Request
Employee
Leave
Signature
Signature
Date
Why this form exists, and what it will not do
Sick Leave Request is for an employee reporting sick time. The moment to use it: as soon as you can, including the day you return if you could not write sooner. It sits in the Employment group on Papero. Applications, time records, leave requests, and letters a private employer can read.
Fill it in this browser. Papero does not create an account, does not upload the answers, and does not keep a copy after you close the tab. When the preview looks right, print it or download a PDF. The PDF is built on your device. A blank download leaves the lines empty so someone else can fill them by hand.
Work through the page in order. The Employee section asks for Name, Manager. The Leave section asks for First sick day, Last sick day, Note attached, Comment.
Name. Your name. Manager. Who should receive this. First sick day. Start.
Last sick day. End, or the same day. Note attached. Whether a clinic note is clipped on. Comment. Optional. You may leave this as "ill" with no further detail.
People send this back, or refuse it, for ordinary reasons. A diagnosis is written when a date range would do. The days do not match the time clock. You needed protected leave and used this instead of asking. Read the finished page once as if you were the person receiving it. If a line would make you call back, fill that line.
Sign on the Signature and Date line. A typed name in the signature spot is weaker than ink on a printed page. Date it the day you sign, not the day you hope the other person signs.
What this page cannot do: This is not an I-9, a W-4, a W-9, or a state new-hire form. Those come from the employer and from the agency. Private employment is generally at-will, with a well-known limit in Montana for employees past probation. A letter here does not create a job, end a job, or set the deadline for a final paycheck. That deadline is state law. Papero is not a law firm, not a government agency, and not the office that will accept or reject the paper.
State note for your state. Sick Leave Request does not contain your state's required clauses, font size, language, or filing fee. Counties and cities inside your state sometimes add their own rule on top of the state. Before you rely on this for a lease, a school, a court, a bank, or an agency, compare it with the form that office publishes. If the office has no form, this template is a clear record of what you wrote and what you signed on this date.
After you print, use dark ink. Write "not applicable" on a line that does not apply, so a clerk does not treat a blank as a missing fact. Initial a correction beside the line. Do not cover a dollar amount with correction fluid. Each person who has a signature line signs their own name. One person cannot sign for another unless a statutory power of attorney, on the form that office accepts, already says so. Give the other party a copy the same day. On your copy, note the date and whether you handed it over, mailed it, or uploaded it to their portal. Attach copies of supporting papers, not your only original, unless the office demanded the original. Do not attach a Social Security card, a passport image, or a bank statement unless the recipient told you to, and then only in person or through their secure portal. Email is a common way those images are stolen. If the recipient is a government office, stop and use the form on that office's own site. Papero does not transmit this page, does not notarize it, and does not store it.
Keep a copy. Give the other party a copy. If you later change a fact, fill the form again and date the new copy. Do not scribble a second story into the margin of a page someone already signed. Write the date you handed it over, and how, on your own copy.
Before you rely on it
- A diagnosis is written when a date range would do.
- The days do not match the time clock.
- You needed protected leave and used this instead of asking.
This is not an I-9, a W-4, a W-9, or a state new-hire form. Those come from the employer and from the agency. Private employment is generally at-will, with a well-known limit in Montana for employees past probation. A letter here does not create a job, end a job, or set the deadline for a final paycheck. That deadline is state law.
How to fill and print it
- Fill the lines. Type into the Sick Leave Request in this browser. Write "not applicable" on a line that does not apply. What you type stays in this tab and is not uploaded.
- Check the preview. The boxed preview is the page that prints. Read it once as the person who will receive the paper.
- Print or download. Use Print, or download a filled PDF or a blank PDF. The file is built on your device.
More Employment forms
Questions
What is a Sick Leave Request used for?
A sick leave request tells a workplace you were out or will be out because you were ill, and which days payroll should mark.
Who should use this Sick Leave Request?
It is for an employee reporting sick time. Use it when as soon as you can, including the day you return if you could not write sooner.
Does this Sick Leave Request need a notary?
No. This Sick Leave Request has no notary block. Sign the Signature, Date line in ink on the printed page if you are handing it to someone.
Will a Sick Leave Request from Papero be accepted?
A diagnosis is written when a date range would do. This is not an I-9, a W-4, a W-9, or a state new-hire form. Those come from the employer and from the agency. Private employment is generally at-will, with a well-known limit in Montana for employees past probation. A letter here does not create a job, end a job, or set the deadline for a final paycheck. That deadline is state law.
What gets a Sick Leave Request sent back?
A diagnosis is written when a date range would do. The days do not match the time clock. You needed protected leave and used this instead of asking.