Leave Application Request Form

                                                                                                    

Date: __________________

NAME: POSITION: EMP.#

DEPARTMENT: LOCATION: JOINING DATE:

DATE OF LEAVE Type of Leave

RE-JOINING DATE
FROM TO No. OF DAYS Privilege __ Sick __ Emergency_ Exam__ Extra Off__

New Born__ Marriage__ Death__ Others:

TICKET ENTITLEMENT YES __ NO __

REASON:

CONTACT WHILE ON LEAVE

NAME OF PERSON ADDRESS TELEPHONE NO.

SIGNATURE OF EMPLOYEE_______________________________ DATE:

APPROVAL BY
Replacement during vacation
SIGNATURE

Name of Direct Manager:_________________________________________ _____________________ ___________________________________

__________________________________
Name of Department Manager:_____________________________________ ____________________ __________________________________

REVIEW PAYROLL SECTION DATE OF LAST LEAVE FOR CONTRACT YEAR

DATE OF JOINING
CONTRACT PERIOD FROM TO FROM TO
LEAVE CYCLE
FROM TO

Current Leave Entitlement

FOR FAMILY STATUS ONLY

RELATION AGE Previous Balance as of

DEPENDENT NAME Days
/ /
Accrual leave Days as of
/ / Days
ADD
IF Days
ANY Days
Days

Total Days
Less Leave Requested Days
Leave Balance up to / / Days
Salary To Be Paid Up to

HR Office SIGNATURE DATE:

TO BE COMPLETED BY Direct Manager UPON RETURN FROM LEAVE

Date of Return: On Time Late: No. Of Days Late:______

Remarks:

Signature (Direct Manager): __________________________ Date: