Request Caregiver Leave (Document Template)

First Name Last Name

Personal Address

Function

[Recipient]

Recipient Address

Common, the date

(Letter recommended with AR: titleContent or hand delivery against discharge)

Subject: Request for compassionate care leave

Madam / Sir / Quality,

I inform you of my intention to take a caregiving leave to accompany my [relative concerned] .

I wish to take this leave as of [date] , for a period of [envisaged duration] .

I want to take my leave [Continuously / in installments according to the attached estimated timetable / as part-time at (Quota)]

Please find enclosed the supporting documents that allow me to benefit from the caregiving leave.

Please accept my distinguished greetings.

[Signature]

Verified 28 July 2022 - Directorate for Legal and Administrative Information (Prime Minister)

For details, please use the practical information sheets :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.