Job Leave Medical Form

Medical Leave and Authorized Forms

Every employer sets aside a certain number of days which can be availed by employees for medical leave. The number of days varies in different organizations. However, this leave can be availed at any time of the year by filling out a job leave medical form. This form provides comprehensive medical information to an employer about an employee in order to approve the leave request.

A medical leave form consists of the applicant’s particulars such as name, national identity number, sex and age. In addition, it is also very important for the name and signature of the physician to be on the form in order to verify the patient’s physical condition. The physician provides a brief diagnosis of the applicant’s illness and recommends the number of days he/she should take off for rest at home. The format of the job leave medical form may vary slightly according to different organizations which require certain information to be presented as mandatory for the leave request.


By signing the medical leave form, a physician takes responsibility for the validity of the provided information. In this way, it is ensured that employees do not misuse this form by presenting misinformation for the approval of leave without any justified reasons.

This medical form can be requested by an employee in order to seek leave from office. Alternatively, doctors may also prescribe rest from work to their patients through this form. Therefore, it is a very important piece of paper in the working world.

job leave medical form template

Medical Leave Form Template
Microsoft Word document file | File size 71 KB | Download