Leave Request Form

Yayasan Mahajana Sosial Fondasi

Full name: Mikhael Yosia

Dates inclusive
No. of working
From To
days
22 November 3 December
Annual leave* 10

Sick Leave (certified) **

Sick Leave (uncertified) **

Compensatory Time Off***

Other types of leave* (please specify)
(i.e. Maternity leave, Paternity Leave, etc.)

I have accrued 10 days annual leave at the end ofOctober. Indicate last completed month.

In My Absence, my work will be covered by.

Signature of Date:
Staff Member: 01/11/2021

Approval by immediate supervisor/medical focal point**

Signature: Date:
Name:

Please note:
* Requires supervisor's approval.
** Supervisor’s approval not necessary, however s/h must inform supervisor and leave monitor when on sick leave.
For “certified” sick leave, medical certification should be submitted to Medical Focal Point for approval.
*** Related Overtime Request Form signed by supervisor should be attached.

Please forward the signed form to your Leave Monitoring focal point.