PT.

PANAH DUNIA PERKASA

GSD TELKOM PROPERTY AREA I

FOMULIR PENGAJUAN CUTI/IJIN

LEAVE APPLICATION FORM
Name/ Nama

Position / Jabatan

No. Badge / NIK

Job Location / Loker :

Date / Tanggal

Signature / TTD

Tandai tipe cuti / Izin yang akan diajukan:

Please indicate the type of leave requested
Cuti/izin Sakit/ Leave/ Sick

Izin Khusus Tidak Berbayar/ Special Leave WithPay

Izin/cuti yang belum diambil/Outstanding Leave

Izin Khusus Berbayar/ Special Leave With Pay

: ..........................................................................................................................................................................................
:
Cuti tersebut di atas dapat diambil dengan persetujuan Facility Manager / Building Manager.

Tanggal Mulai Cuti/ Date of commencement

sampai dengan/ to

Jumlah Hari:

DILENGKAPI OLEH FM / BM PADA KASUS CUTI SAKIT

To be completed by Facility / Building Manager in case of SICK LEAVE
Yes
Ketidakhadiran diberitahukan sebelumnya

Absence notified prior to commencement of shift

Surat sakit dari instansi medis

Medical Certificate required (attached if required)

Izin Cuti Sakit dikabulkan

No

FM / BM

LEAVE APPROVAL
Memberi Persetujuan

KORLAP

tanggal/ date:

FM / BM

tanggal/date:

tanggal/ date