Here is a sample leave of absence letter due to back pain. Certified mail should be used to send the letter in order for the employee to have proof that they sent the letter within the prescribed time.
If there are any documents enclosed such as a letter from a doctor or medical records, only copies should be sent and never original documents.
Sample Leave of Absence Letter Due to Back Pain
89 Kendall Street
Vargas, ND 74569
Dear Mr. Jamison,
As you are well aware, I have been having back pain. Though many methods have been explored for how to correct the problem, surgery is inevitable. The reconstructive surgery on my knee will require a lengthy absence from work. I am so sorry that I have to do this to you, but I am going to have to take the full 12 weeks allowed with FMLA.
My doctor has filled out the request form, which I got from HR. I have attached this to this letter to begin the process. In an effort to be fair to a company that I enjoy working for, I am allowing you a month’s notice to make other arrangements for my position. My surgery is scheduled for February 16th. I can work until the 15th of February, to ensure that there is adequate coverage.
If you need me to train anyone to cover my position, or to wrap up some business matters, I would be more than willing. I anticipate that my return will be [DATE]. While this is just an estimate, I want you to be prepared. I hope to return before this time and to retain my rightful position.
I appreciate your consideration in this matter. You have always been great to work for through the years and I know you will understand that this is something that must be done. If you have any questions, please feel free to let me know.
Tatum G. Clark
By Andre Bradley