453
Building Services of America Unpaid Leave of Absence Request Form
Employees who meet the eligibility criteria for a leave of absence must complete this form at
least 30 days prior to the commencement of leave or as soon as practicable in the event of an
unforeseeable absence. Please note:
• All leaves of absence must be approved in advance by human resources (HR) and the
employee’s supervisor.
• If the dates of requested leave change, a new leave of absence request form must be
submitted for approval.
• Employees on an unpaid leave of absence are responsible for payment of insurance
premiums as agreed upon with HR prior to the commencement of leave.
• Employees returning from a leave of absence must contact HR at least one week in
advance of the projected return date.
Refer to the BSA Employee Handbook for the full details on unpaid leaves of absence, including
eligibility.
- Employees must initiate leave requests through the Paycom Ask Here Dashboard.
- After requesting leave through Paycom, please complete the Unpaid Leave of Absence request form attached at the bottom of this page 👇 and email it to [email protected]
