State of __________ Rev.

133C973

LEAVE OF ABSENCE AGREEMENT

This Leave of Absence Agreement (the "Agreement") is made as of this __________, (the “Effective
Date”) by and between __________ (“Company”), located at __________, __________,
__________ __________, and __________ (“Employee”), residing at __________, __________,
__________ __________. Employee is presently serving as __________. In consideration of the mutual
covenants and agreements herein, the parties agree as follows:

1. Leave. Employee seeks a leave of absence due to __________. The Company has granted the
leave of absence starting on the date of __________ until __________. Employee will return to the
Company on the next business day.

2. Compensation. During the leave of absence, Employee will receive __________ of their normal
salary. Employee will not hold any position or titles while on the leave of absence. Employee is not
entitled to any benefits during this time off unless required by law.

3. Employee Covenants. In consideration of continued employment with the Company, Employee

covenants that during their leave of absence from the Company that Employee will not engage in,
own, or control any business or be employed in any capacity. Employee will not solicit the business of
any client of the Company during this time.

4. Termination. Failure to comply with the terms of this Agreement will result in termination of
employment.

5. Injunctive Relief. Employee acknowledges that breach of any of the covenants will give rise to
irreparable injury to the Company. Employee acknowledges that such injuries are not adequately
compensable by damages and that injunctive relief against such breach is available as a legal remedy.
Employee agrees that the covenants herein are necessary for the protection of the Company’s
legitimate business interests.

6. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the parties and
their respective legal representatives, heirs, administrators, executors, successors and permitted
assigns.

7. Severability. If any provision of this Agreement is held to be invalid, illegal or unenforceable in

whole or in part, the remaining provisions shall not be affected and shall continue to be valid, legal and
enforceable as though the invalid, illegal or unenforceable parts had not been included in this
Agreement.

8. Governing Law. The terms of this Agreement shall be governed by and construed in accordance
with the laws of the State of __________, not including its conflicts of law provisions.

9. Dispute Resolution. Any dispute arising out of or related to this Agreement that the parties are
unable to resolve by themselves shall be settled by arbitration in the State of __________ in
accordance with the rules of the American Arbitration Association. The written decision of the
arbitrator(s), as applicable, shall be final and binding. Judgment on a monetary award or enforcement
of injunctive or specific performance relief granted by the arbitrator(s) may be entered in any court
having jurisdiction over the matter.

Leave of Absence Agreement (Rev. 133C973) 1/1

 10. Headings. The section headings herein are for reference purposes only and shall not otherwise
affect the meaning, construction or interpretation of any provision in this Agreement.

11. Entire Agreement. This Agreement contains the entire understanding between the parties and
supersedes and cancels all prior agreements of the parties, whether oral or written, with respect to
such subject matter.

12. Amendment. This Agreement may be amended or modified only by a written agreement signed by
all of the parties.

13. Notices. Any notice or other communication given or made to any party under this Agreement
shall be in writing and delivered by hand, sent by overnight courier service or sent by certified or
registered mail, return receipt requested, to the address stated above or to another address as that
parties may subsequently designate by notice and shall be deemed given on the date of delivery.

14. Waiver. No party shall be deemed to have waived any provision of this Agreement or the exercise
of any rights held under this Agreement unless such waiver is made expressly and in writing. Waiver
by any Partner of a breach or violation of any provision of this Agreement shall not constitute a waiver
of any other subsequent breach or violation.

IN WITNESS WHEREOF, this Agreement has been executed and delivered as of the date first written
above.

__________

Company Representative Signature Company Representative Full Name

__________

Employee Signature Employee Name

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GENERAL INSTRUCTIONS The Consequences of Not Having One

Without a leave of absence agreement, employees have

What is a Leave of Absence Agreement?
no guarantee their job, or a similar position, will be
available for them when they are ready to return from
A Leave of Absence agreement is a written agreement leave. Employers face uncertainty about when or whether
between an employer and an employee. It documents the an employee will return. Without reducing the agreement
terms and conditions of an employee’s leave of absence to writing, unintended consequences often present
from a business. A leave of absence agreement grants an themselves. Failing to use a written document detailing
employee an absence from their job for a specific length the terms of the leave, leaves the initial intentions ,and
of time, so they may attend to other matters. The agreed upon obligations, to one’s memory, making it
employer agrees to hold the employee’s job for the highly susceptible to change or breach.
employee upon return from leave. The employee agrees
to return at a specified time. Depending on the facts and
Disputes regarding the terms of the leave may result in
circumstances of an individual case, a leave of absence
unhappy employees, employers short of staff they need
agreement may include additional requirements that are
to complete the work, and, in some cases, lawsuits.
fact specific. Some examples include:

 A requirement the employee document job The Most Common Situations of Using One
specific training while on leave;
 Documentation of a medical need; or An employer has the option of using a leave of absence
 Regular updates regarding the purpose of the agreement in any situation they believe merits granting a
leave. leave of absence. However, the most common reasons
for using a leave of absence agreement include the same
When Employers Need a Leave of Absence reasons listed under the Family and Medical Leave Act
(FMLA). Of course, the FMLA only covers employers and
Agreement employees who meet certain criteria. Most common
When a valued employee indicates a desire to leave reasons for a leave of absence include:
employment for personal reasons, you as an employer
may wish to execute a leave of absence agreement,
 The birth of a child;
which offers the employee assurances you will hold their
job for them while they are away. You can set the terms  The adoption of a child;
and conditions.  A child placed in the home in foster care;
 An employee dealing with a serious health
condition; or
When Employees Need a Leave of Absence  A situation arising out of an emergency related to
Agreement a spouse, child, or parent on active duty status.
If you are planning to take a leave from employment, a
leave of absence agreement protects you and your There may also be other situations where an employer
position in the company. Leave of absence agreements may, but is not legally required to agree to a leave of
are contracts -- a written guarantee you won’t lose your absence.
job, your seniority, or your place in the company as a
result of your leave. It also details expectations about
benefits, conditions which must be met during the leave What Should the Agreement Include?
and immediately prior to return from leave, and how an
employee’s leave may transform into a termination.  Dates of the Leave
 Extension Details of the Leave
 Other Details Regarding Leave
For Both Employers and Employees
 Details about Benefits (If Any)
A leave of absence agreement defines the terms and
conditions of a leave. Any time an employee takes a  Details about the Job Position
leave of absence, a written agreement defining the terms
of the leave and the expectations of both parties protects
the rights of both.

Leave of Absence Agreement (Rev. 133C973)