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PT.

Bisnis Plus Sosial


APPLICATION FOR LEAVE
DIVISI : _________________ PERMOHONAN CUTI/IZIN
NAME EMPLOYEE NO
NAMA NO KARYAWAN
POSITION DEPT DATE JOINED
JABATAN BAGIAN TGL BEKERJA
LEAVEREQUEST TAKEN/STARTING FROM DATE
PERMOHONAN CUTI/IZIN MULAI DARI TGL ____________________________________

UNTIL DATE ____________________________________


S/D TGL

NO OF DAYS ____________________________________
JUMLAH HARI
LEAVE OF ABSESI ANNUAL VACATION
IZIN MANGKIR CUTI TAHUNAN W.DAYS / H.KERJA

SICK CARRY OVER 20 ___________________________________


SAKIT PINDAHAN 20

OTHERS ENTITEMENT 20 ___________________________________


LAIN2 HAK CUTI 20

PLEASE SPECIFY SUB TOTAL ___________________________________


ALASAN
TAKEN IN 20 ___________________________________
________________________________ TELAH DIAMBIL 20
________________________________
________________________________ BALANCE / SISA ___________________________________
________________________________
________________________________ VACATION REQUEST ___________________________________
________________________________ PERMOHONAN CUTI TAHUNAN
________________________________
________________________________ TO BE TAKEN ()
________________________________ REVISION ()
CANCELLATION ()
DATES SEE ABOVE ___________________________________

BALANCE REMAINING AT END THIS VACATION ___________________________________


SISA YANG TINGGAL PADA AKHIR CUTI
MY MAILING ADRESS DURING VACATION
ALAMAT SAYA SELAMA CUTI
_________________________________________________________
_________________________________________________________
________________________TELP ____________________________

REQUESTED BY/ DIMINTA OLEH APPROVED BY / DISETUJUI OLEH

EMPLOYEE / KARYAWAN MANAGER / PIMPINAN


DATE / TANGGAL DATE / TANGGAL

HRD 11.1 Rev.00 Tanggal 15 September 2015

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