Leave Request (Wniosek urlopowy)

LEAVE REQUEST (WNIOSEK URLOPOWY)

Employee: ✓Employee Submitted on: Date the request is submitted

1. TYPE AND DATES 1.1. Type of leave: Type of leave (rodzaj urlopu) 1.2. From Leave start date to Leave end date, Number of days requested day(s). 1.3. ⚠️ Urlop na żądanie: up to 4 days per calendar year, may be requested with no advance notice — the Employer must grant it (subject to very narrow refusal grounds). Urlop opiekuńczy: up to 5 days/year, unpaid. Urlop z powodu siły wyższej: up to 2 days (or 16 hours)/year, paid at 50%.

2. BALANCE 2.1. Remaining leave balance for the year: Remaining leave balance for the year 2.2. ⚠️ Base annual entitlement is 20 or 26 days depending on seniority (staż pracy). From 2026, periods of umowa zlecenie and JDG also count toward staż pracy — leave-entitlement bases for affected employees may need to be recalculated.

3. COVERAGE DURING ABSENCE 3.1. Coverage arrangement during absence

4. APPROVAL 4.1. Status: Approval status

Employee ______________ / ✓Employee / Approved by ______________

— — — ⚠️ This is a boilerplate template, not legal advice. Polish employment, data-protection and consumer-protection law (the Kodeks pracy — Labour Code, arts. 25¹, 29, 29 §3; the RODO/GDPR — Regulation (EU) 2016/679; the ustawa o minimalnym wynagrodzeniu za pracę; the ustawa o świadczeniu usług drogą elektroniczną; and the ustawa o prawach konsumenta) is highly procedural, tied to fixed statutory deadlines (the "syndrom pierwszej dniówki" under art. 29 KP, the 7-day informacja o warunkach zatrudnienia, the 33-month/3-contract fixed-term cap, the 14-day right of withdrawal, the last-working-day świadectwo pracy) and changes frequently — including the 2026 minimum wage (4 806 zł/month, 31,40 zł/hour), the staged staż pracy reform (01.01.2026 for the public sector / 01.05.2026 for the private sector, with a 24-month window to document past periods) and the foreign-worker work-notification deadline shortened from 14 to 7 days as of 05.03.2026. Have this document reviewed and adapted by a Polish employment/ legal advisor (radca prawny / adwokat) and verified against current PIP, ZUS and UODO thresholds and guidance before use.