Leave Verification Form


A leave verification form is required to authorize the individual applying for a leave. The form contains details like the reason for applying the leave and also other information like the employment details of the individual and the total number of leaves availed.

Sample Leave Verification Form:

Employee details:

Name of the employee: First name _______ Middle name __________ Surname _______

Designation: __________

Employee id number: _________

Department: __________

Department extension number: ___________

Leave details:

Reason for taking leave: __________________________

Leave application dates:

From: ___________

To: _____________

Total number of days applied for leave: ___________

Total number of paid leaves allotted per year: ______________

Leaves already taken:

Casual leave: From _________ to _______________

Special Casual Leave: From _________ to ______________

On Duty Leave: From _________ to ______________

Sick leave: From _________ to ______________

Other leave: ______________

Status of leave applied (select the appropriate option):

  • Approved
  • Rejected

If rejected, reasons for rejection: _____________________________________

__________________                                                     Dated: ____________

Signature of applicant

_____________________                                               Dated: _____________

Signature of behalf of employer


Category: Verification Forms

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