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**DRC's COPY **EMPLOYEES' COPY

Leave Form Leave Form


(Leave with Pay, Leave without Pay, Outside Business, Undertime) (Leave with Pay, Leave without Pay, Outside Business, Undertime)
Name: Department: Name: Department:

Please check the appropriate box: Date Filed: Please check the appropriate box: Date Filed:
  Leave with   Leave without Pay   Leave with Pay   Leave without Pay
Pay
FROM TO FROM TO
TOTAL TOTAL
Month Date Month Date Month Date Month Date

Day Day

Please check the appropriate box: Please check the appropriate box:
  Outside Business   Undertime   Outside Business   Undertime
OUT IN OUT IN
TOTAL TOTAL
Date Time Date Time Date Time Date Time

Hour Hour

Reason: Reason:

Destination: Destination:

Attach Documents (If required): Attach Documents (If required):

Shift Worker (1) Date Shift Worker (2) Date Supervisor Shift Worker (1) Date Shift Worker (2) Date Supervisor

PM/ PA/ QM HR Manager Plant Manager PM/ PA/ QM HR Manager Plant Manager