LEAVE FORM

NAME OF EMPLOYEE: (Last, First, Middle) POSITION / DESIGNATION:

PROJECT / DEPARTMENT:

TYPE OF LEAVE / ABSENCE: DATE DATE TOTAL DAYS OF LEAVE

(Check appropriate boxes below) FROM (Month, Day, Year) UNTIL (Month, Day, Year) OR ABSENCE
VACATION LEAVE WITH PAY

SICK LEAVE WITHOUT PAY

EMERGENCY LEAVE

PURPOSE OF VACATION LEAVE: PURPOSE OF SICK LEAVE: REASON FOR AN EMERGENCY LEAVE:
ILLNESS . INJURY / INCAPACITATION OF
REQUESTING EMPLOYEE

MEDICAL / DENTAL / OPTICAL EXAMINATION

OF THE REQUESTING EMPLOYEE
CARE OF FAMILY MEMBER INCLUDING
MEDICAL / DENTAL / OPTICAL EXAMINATION
OF FAMILY MEMBERS OR BEREAVEMENT
CARE OF FAMILY MEMBER WITH A SERIOUS
HEALTH CONDITION

OTHERS: PLEASE SPECIFY

REMARKS

CERTIFICATION: I HEREBY REQUEST LEAVE / ABSENCE FROM DUTY AS INDICATED ABOVE AND CERTIFY THAT SUCH LEAVE /
ABSENCE IS REQUESTED FOR A PURPOSES INDICATED. I UNDERSTAND THAT I MUST COMPLY WITH THE EDCOLAND
MANPOWER SERVICES PROCEDURES FOR REQUESTING LEAVE OF ABSENCE (AND PROVIDE ADDITIONAL
DOCUMENTATION, INCLUDING MEDICAL CERTIFICATE)

REQUESTING EMPLOYEE (NAME AND SIGNATURE) DATE:

PROJECT IN CHARGE RECOMMENDING APPROVAL (NAME AND SIGNATURE) DATE:

This section is to be filled and signed by the Department Head and Edcoland Manpower Services management
(If disapproved, state the reason &
OFFICIAL ACTION ON REQUEST: APPROVED DISAPPROVED
initiate action to reschedule)
DEPARTMENT HEAD'S APPROVAL (NAME AND SIGNATURE) DATE:

HUMAN RESOURCES DEPARTMENT

VACATION LEAVE SICK LEAVE
TOTAL LEAVE :
TOTAL LEAVE USED :
REMAINING LEAVE :

VERIFIED BY THE HUMAN RESOURCES DEPARTMENT

OLIVER ROY CRUZ Date ISRAEL RAÑADA JR. Date

Human Resources Staff Human resources Manager

PRESIDENT APPROVAL (NAME AND SIGNATURE) DATE:

RICHARD C. ABITONG
REFERENCE NO. EMS (LF - 001) EFFECTIVITY DATE: JANUARY 01, 2017
PAGE 1 OF 1 VALIDITY DATE:: DECEMBER 31, 2018