Dear…

RE: Leave of Absence

__(Name of Organization)__ acknowledges your request for a Leave of Absence from your current employment for the period of __(date)__ to __(date)__. Please allow this letter to serve as confirmation that we are prepared to grant to you this __(length of time: i.e. - 10-month)__ Leave without pay. Regrettably however, we are not able to guarantee to you, return to your current position of __(name of position)__ once you return from your Leave.

Please be aware that a position within our organization will be made available to you upon your return, but at this time, we are unable to identify what type of position that will be. We further wish to make you aware that should you decide to accept the position offered to you at the time of your return, your __(salary/wages/remuneration package/etc.)__ may be subject to adjustment in accordance with that particular position.

We ask you to confirm, by signing and returning a duplicate copy of this letter, that you will be taking an extended Leave of Absence from __(Name of Organization)__ under these terms, commencing __(date)__ and returning to employment on __(date)__. Please provide a signed copy of this letter to __(Name of Person/Department)__ no later than __(date)__. Thank you.

Yours truly,

Your signature

__(your name & position)__

I UNDERSTAND AND ACCEPT the terms of the Leave of Absence as outlined above.

Yes ___ No ___

Leave of Absence Term: __(date)__ to __(date)__

____________________________ _________________

Signature of Employee Date