Get our app
Account Sign up Sign in

MAKE YOUR FREE Short-Term Disability Leave Agreement

Make document
Other Names: Medical Leave Agreement Short-Term Medical Leave Agreement Short-Term Leave Agreement
Short-Term Disability Leave Agreement document preview

What is a Short-Term Disability Leave Agreement?

A Short-Term Disability Leave Agreement is an agreement between an employer and employee that grants a temporary leave of absence to the employee for a specific period of time to manage personal or family emergencies, injuries, or illnesses. These agreements can help protect everyone involved, including the employee, employer, and other workers. They also make it easier for the business to adjust when an employee has to take time off.

A Short-Term Disability Leave Agreement typically defines the terms and conditions that the employee needs to fulfill during their absence, as well as the compensation and other benefits they are entitled to during the specified period. This agreement ensures that both the employer and employee are aware of their responsibilities and can plan accordingly during the leave of absence.

When to use a Short-Term Disability Leave Agreement:

  • You're an employer and want to have documents in place in case of emergency.
  • Your employee needs to take leave of absence from work for a specific period and you want to set out the conditions for such absence.
  • You want to take leave of absence from work and want to request that your job be retained during your absence. 

Sample Short-Term Disability Leave Agreement

The terms in your document will update based on the information you provide

Rocket Lawyer members have customized over 93.5M documents
Legally binding and enforceable
Ask a lawyer questions about your document
Sign this document online for free with RocketSign®




This Agreement (the Agreement) made and entered into as of , between , , , (the Company) and , , , , an individual (Employee).


In consideration of the mutual covenants and agreements hereinafter set forth, the parties agree as follows:


Reasons for Leave

The Employee can seek a Leave of absence for the following reasons, including but not limited to (a) personal reasons (b) illness or injury, or (c) short-term disability. The Company, based upon the needs of its operation and for good and sufficient cause, shall grant leave of absence to employees who qualify under the guidelines and requirements set forth in the Companys employee handbook and policies manual. Employee is seeking a leave of absence for the following reasons: .


Duration of Leave

Employee has requested, and the Company hereby grants leave of absence from his/her full-time employment, commencing and ending , subject to the conditions of this Agreement. Employee is expected to return to work the earliest work day following .


Compensation During Leave of Absence

Except as otherwise provided in this Agreement, the Employee will be considered an employee during the period of leave-of-absence. During Employee's paid leave-of-absence, the Company will continue to pay the employee the amount of his/her current base salary. Employee shall not hold any title or position with the Company, and shall have no titles, duties, responsibilities or authority with respect to the Company and its operations. Employee shall not be entitled to benefits including paid time off and holiday pay. However, group medical benefits shall remain in force during the Employees leave of absence and employee and any of his/her applicable dependants shall be entitled to such group benefits.


Protection of Rights

Employees seniority rights shall not be affected by his/her inability to work because of proven sickness or injury. The Company will not modify the Pension Plans or any other plans or benefits under which Employee is entitled to participate in a manner which would result in differential treatment to the employee. Employee's right to exercise nonqualified stock options will be administered in accordance with those Plans, and shall continue so long as Employee is employed by the Company and for such period of time as provided by such Plans upon Employee's retirement.



During the period of absence, Employee shall not (i) directly or indirectly, accept any employment, consult for or with, or otherwise provide or perform any services of any nature to, for or on behalf of any person, firm, partnership, corporation or other business or entity that is engaged in similar kind of business done by the Company. Failure to comply with this provision shall result in the complete loss of seniority rights for the Employee.


Extension of Leave of Absence



If the Employee fails to return to work by the time prescribed in this Agreement, the employee may be terminated from employment.


Miscellaneous Provisions

(a) Governing Law: The laws of the State of shall govern the Agreement.


(b) Severability: In the event, any one or more of the provisions contained in this Agreement shall for any reason be held invalid, illegal, or unenforceable in any respect, that invalidity, illegality, or unenforceability shall not affect any other provision. This Agreement shall be construed as if the invalid, illegal, or unenforceable provision had never been contained in it.


(c) Amendments: This Agreement may be amended by the parties only by a written agreement.


(d) Attorneys' Fees: If any action at law or in equity is brought to enforce or interpret the provisions of this Agreement, the prevailing party will be entitled to reasonable attorneys' fees in addition to any other relief to which that party may be entitled.


(e) Headings: Headings used in this Agreement are provided for convenience only and shall not be used to construe meaning or intent.


(f) Signatures: This Agreement shall be signed by on behalf of and by .




By: Date:

By , its







By: Date:


Short-Term Disability Leave Agreement document preview

Create Your Document In Just 3 Easy Steps:

Build your document

Build your document

Answer a few simple questions to make your document in minutes

Right-facing arrow
Save, print & share

Save, print & share

Save progress and finish on any device, download & print anytime

Right-facing arrow
Sign & make it legal

Sign & make it legal

Securely sign online and invite others to sign

Right-facing arrow

Looking for something else?

Start your Short-Term Disability Leave Agreement now and get Rocket Lawyer FREE for 7 days

Get legal services you can trust at prices you can afford. You'll get:

All the legal documents you need—customize, share, print & more

Unlimited electronic signatures with RocketSign®

Ask a lawyer questions or have them review your document

Dispute protection on all your contracts with Document Defense®

30-minute phone call with a lawyer about any new issue

Discounts on business and attorney services