Control No.

______________

LEAVE OF ABSENCE FORM v.09012020

DATE FILED : __________________________________

EMPLOYEE NO. : _________________________________

EMPLOYEE NAME : __________________________________

POSITION : __________________________________

The undersigned is requesting for a leave of absence for ____ days, from _____________ to

_________________.

REASON:
_________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________.

Address while on leave: __________________________________________________________

Contact No. _________________________________

Remarks: ___________________________________

_________________________________
Employee’s Signature over Printed Name

Recommending Approval:

________________________________

Approved:

_______________________________