[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-276200-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-276200-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","application-for-sick-leave-form-template","Application for Sick Leave - Form Template","","Application form requesting sick leave pay for specified hours or days, with coverage dates stated as an inclusive on/from-to period. Includes employee identification fields such as name, job title, and division/department, plus a reason for the request and employee signature with date. Contains certification sections for superintendent, supervisor, or foreman, and a physician/attending physician certificate when doctor visit treatment is involved. Notes legal penalties for fraudulent claims and certification.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/application-for-sick-leave-form-template/276200/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/application-for-sick-leave-form-template/276200.png","ImageObject",442,249,{"name":42,"@type":43},"eBook King","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-01","2026-09-15",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"When should this sick leave application form be used?","Question",{"text":63,"@type":64},"Use it when non-doctor related attention or additional needed attention is required, or when visiting a doctor. The form includes doctor-related certification sections accordingly.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What information must the employee provide?",{"text":68,"@type":64},"The employee provides the sick leave duration (hours or days) and the inclusive dates, along with employee name, job title, division/department, reason for the request, and an employee signature with date.",{"name":70,"@type":61,"acceptedAnswer":71},"What are the rules for sick leave lasting more than three days?",{"text":72,"@type":64},"If sick leave continues for over three (3) days, a doctors excuse form must be submitted. For sick leave exceeding three or more working days, medical certification is required, and if it continues for more than seven (7) days, a new form must be submitted weekly.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},276200,1790355915,{"code":4,"msg":82,"data":83},"success",[84,89,93,98,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","APPLICATION FOR SICK LEAVE  \nUse this form for non-doctor related or needed attention.  \nThe undersigned requests sick leave pay for   hour(s) / day(s)  \nOn/from   to   all days inclusive. Employee Name   Job Title   Division/Dept   Reason for request of sick leave    \n\n| Employee Signature   Date  \u003Cbr>I hereby certify that the above statements are true and correct and that I have full knowledge of the penalty for making fraudulent statements in order to obtain sick leave pay. |\n| --- |\n| ---NOTE---\u003Cbr>IF SICK LEAVE CONTINUES FOR OVER THREE (3) DAYS, A DOCTORS EXCUSE FORM MUST BE\u003Cbr>SUBMITTED |\n| CERTIFICATE OF SUPERINTENDENT, SUPERVISOR OR FOREMAN\u003Cbr>I hereby certify that the above employee notified me as required on the fact or their absence and the reason for sick leave, which prevented them from performing their regular duties.\u003Cbr>Signature   Date   |\n\nThe law provides that an employee fraudulently obtaining sick leave pay or the false certification of sick leave by the superior for absence from work for reasons other than approved sick leave may be  \nsuspended, dismissed and/or prosecuted.  \nAPPLICATION FOR SICK LEAVE  \nUse this form when visiting a doctor.  \nThe undersigned requests sick leave pay for   hour(s) / day(s)  \nOn/from   to   all days inclusive. Employee Name   Job Title   Division/Dept   Reason for request of sick leave    \nEmployee Signature   Date    \nI hereby certify that the above statements are true and correct and that I have full knowledge of the penalty for making fraudulent statements in order to obtain sick leave pay.  \nI certify that   was treated on  (employee name) (date(s) of sickness)  \nor that the employee named above, while not treated by me, was in my office to accompany  \n   for their course of treatment.  \n(patient name) (relationship)  \nSignature of physician   Date    \nI certify that medical attention was warranted or that the above employee is applying for sick leave, which exceeds three (3) or more working days. If sick leave continues for more than seven (7) days, a new  \nform must be submitted weekly.  \nATTENDING PHYSICIAN FOR SUCH PROVISION WAS/IS:  \nName of Physician    \nPlease Print  \nAddress of Physician   \nCERTIFICATE OF SUPERINTENDENT, SUPERVISOR OR FOREMAN  \nI hereby certify that the above employee notified me as required on the fact or their absence and the reason for sick leave, which prevented them from performing their regular duties.  \nSignature   Date    \nThe law provides that an employee fraudulently obtaining sick leave pay or the false certification of sick leave by the superior for absence from work for reasons other than approved sick leave may be suspended, dismissed  \nand/or prosecuted.","cbCaiiua39MoMnGz","https://ap.wps.com/l/cbCaiiua39MoMnGz","pdf",73009,"English","# Application for Sick Leave\n## Employee Request Details\n## Signatures and Certifications\n### Physician/Attending Physician Certificate\n### Superintendent/Supervisor/Foreman Certificate","[{\"question\":\"When should this sick leave application form be used?\",\"answer\":\"Use it when non-doctor related attention or additional needed attention is required, or when visiting a doctor. The form includes doctor-related certification sections accordingly.\"},{\"question\":\"What information must the employee provide?\",\"answer\":\"The employee provides the sick leave duration (hours or days) and the inclusive dates, along with employee name, job title, division/department, reason for the request, and an employee signature with date.\"},{\"question\":\"What are the rules for sick leave lasting more than three days?\",\"answer\":\"If sick leave continues for over three (3) days, a doctors excuse form must be submitted. For sick leave exceeding three or more working days, medical certification is required, and if it continues for more than seven (7) days, a new form must be submitted weekly.\"}]","Application for Sick Leave - Form Template | PDF",1789491863]