LEAVE OF ABSENCE REQUEST FORM

This request for a leave of absence must be discussed with your Leader prior to the requested start date of the leave. If you have additional
questions, please contact Leave Administration.
Please Print
Last Name First Name Personnel Number Phone Number

Dept Name Status Email Address

MILITARY LEAVE
When you receive orders to be deployed for Military Duty, submit this request and a copy of your Military orders to Leave
Administration as soon as possible. Your orders will be processed by Leave Administration.
 Should you have other Military needs not related to orders, please contact Leave Administration.
Start Date:____________________________ End Date:____________________________________

PERSONAL LEAVE
Personal Leaves require approval from your Leader. PLOAs that exceed 30 days require approval signatures from your Leader, Department Head, and
Employee Relations.

All paid time off must be exhausted before an unpaid personal leave is granted Validated all paid time has been exhausted.
Location rehab.
Start Date:____________________________ End Date:___________________________________

FAMILY CARE LEAVE

Cast members must first contact Leave Administration for qualification . Once approved, fill in approved dates and submit to Leave Administration.
Start Date:________________ End Date:________________ Program Currently Approved For: FMLA HFLL
Dependent Name:__________________________________ Relationship to Cast Member:________________________________
Child Bonding? Yes No If Yes, Dependent’s Date of Birth: ____________
Comments:__________________________________________________________________________________________________________________
_____________________________________________________________________________________________________

CHILD BONDING POLICY LEAVE

Cast members are recommended to request a Child Bonding Leave at least 30 days before the start of the leave.
Child Bond time off should be discussed with your Leader prior to submitting this request.
Requesting Bonding Pay? Yes No If Yes, indicate dates to be paid: Start Date: ____________End Date: __________________
Start Date:_________________ End Date:_______________ Relationship to Child:______________ Date of Arrival:____________
Comments:__________________________________________________________________________________________________________________
____________________________________________________________________________________________________

________________________________________________ _____________________________________________
Cast Member Signature Date
Approval Signature Required

______________________________________ ________________ __________________________________ _____________

Leader Approval Signature Date Leader Name-please print Phone ext.

Notification Signature (DLR Only)

______________________________________ ________________ _______________________________________________

WFM Scheduling Manager Signature Date WFM Scheduling Manager Name – Please Print

An incomplete form and/or lack of appropriate qualification (if applicable) may delay processing of your request.
Submit completed form with your Leader’s signature to Leave Administration.
Send this form to Leave Administration via D Tools HR, by email: WDPR.Leave.Administration.Team@disney.com , or by Fax: (407) 934-7224
Revised 2/25/2020