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Dear (insert name of appropriate individual):

I am requesting a personal (paid/unpaid) leave of absence for medical reasons. My first day of leave will be (insert day of week) 10/1/11, and I will return to work on (insert day of week) 10/8/11.

I have attached the supporting medical documentation for your review.

Thank you for considering my request.

Use whatever closing you feel most appropriate - Sincerely, Warm Regards....and your signature.

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Q: Sample leave applications for medical leave?
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