Bereavement Leave Request Form
Instructions – Employees should use this form to request/report absence related to funeral/bereavement. Once the form ha been completed it mut be submitted to the Parish Administratorr. Bereaement Leave may only be taken in half or whole days.
Proof of death maybe asked to be provided, failure to provide proof will result in reversal of leave and non payment for any related days of missed work. Disciplinary action may be taken in cases of fraudulent requets.
Employee Name …………………………………………………………………………..
Job Title …………………………………………………………………………..
Relationship of Family Member
Date of Death
Date of Funeral
Dates of Leave
Total
Days/Hours
From
To
Total Days
Additional Comments:
Approved By: Date:
Parish Administrator Approved: Date:
