Form Roster Salinan

FORMULIR PERMOHONAN CUTI / ROSTER & IZIN
ANNUAL LEAVE / ROSTER & PERMISSION APPLICATION FORM
Nama / Name : Tanggal / Date :
No. Badge/Badge No : Dept / Sect :
Jabatan / Position : Work Location :
JENIS CUTI / IZIN - Type of leave / Permission :
CUTI TAHUNAN / ANNUAL LEAVE IZIN TANPA UPAH / PERMISSION WITHOUT PAY
CUTI MELAHIRKAN / MATERNITY LEAVE ROSTER / FIELD BREAK
Keterangan / Remarks
:
Staff Pengganti Selama Cuti / Roster :

Person incharge while on Leave / Roster
Alamat Selama Cuti :
PERIODE PENGAMBILAN CUTI / IZIN - PERIOD OF LEAVE / PERMISSION
Dari / From : (Tanggal Mulai Cuti / Izin - Start Leave Date)
Sampai / To : (Tanggal Akhir Cuti - End Leave / Permission Date)
Kembali Kerja/Return : (Tanggal Mulai Kerja / Start Work Date)
Jmlh Hari- Nu. Of Working Days :
PEMOHON - REQUESTED BY, DIKETAHUI - ACKNOWLEDGE BY, DISETUJUI - APPROVED BY,
Karyawan - Employee Atasan Langsung - Direct Superior Atasan Langsung - Direct Superior
CATATAN CUTI / IZIN OLEH HRD / ADM - LEAVE / PERMISSION RECORDS BY HRD / ADM
Sisa Cuti - Outstanding Balance : Diperiksa - Checked By,
Cuti Terakhir - Last Leave/Roster was on date :
Cuti Berikut - Next Leave/Roster will be on date : Mulyadi Dechia

HR & Adm. Dept Head
IP-FRM-P&A37-Rev.00
Note : Harap dilampiri dengan surat Pelimpahan Tugas
Nama / Name : Noor Meity Safitri Tanggal / Date : 15 April 2021
No. Badge/Badge No : 1043-KKWT Dept / Sect : HSE
Jabatan / Position : Paramedic Work Location : Senyiur, KM 06
CUTI MELAHIRKAN / MATERNITY LEAVE ✔️ ROSTER / FIELD BREAK
:
Staff Pengganti Selama Cuti / Roster : Hanifah

Alamat Selama Cuti : Muara Kaman, Kukar
Dari / From : 25 April 2021 (Tanggal Mulai Cuti / Izin - Start Leave Date)
Sampai / To : 09 May 2021 (Tanggal Akhir Cuti - End Leave / Permission Date)
Kembali Kerja/Return : 10 May 2021 (Tanggal Mulai Kerja / Start Work Date)

HR & Adm. Dept Head
BR-FRM-P&A37-Rev.00
Nama / Name : Purwanto Tanggal / Date : 01 November 2020
No. Badge/Badge No : 1134 - TP Dept / Sect : CTB-2
Jabatan / Position : Asst Foreman Work Location : Muara Kedang Kepala
CUTI MELAHIRKAN / MATERNITY LEAVE √ ROSTER / FIELD BREAK
: Roster
Staff Pengganti Selama Cuti / Roster : Juhairi & Edi Sesha

Alamat Selama Cuti : Mess - Jawa Tengah
Dari / From : 08 November 2020 (Tanggal Mulai Cuti / Izin - Start Leave Date)
Sampai / To : 22 November 2020 (Tanggal Akhir Cuti - End Leave / Permission Date)
Kembali Kerja/Return : 23 November 2020 (Tanggal Mulai Kerja / Start Work Date)
Jmlh Hari- Nu. Of Working Days : 15 Hari
Purwanto

HR & Adm. Dept Head
MJL-FRM-P&A37-Rev.00
:

PEMOHON - REQUESTED BY, DIKETAHUI - ACKNOWLADGE BY, DISETUJUI - APPROVED BY,
Karyawan - Employee Atasan Langsung - Direct Superior Site Management

HR & Adm. Dept Head
:


HR & Adm. Dept Head
BR-FRM-P&A37-Rev.00
Nama / Name : Asrial Tanggal / Date : 27 January 1900
No. Badge/Badge No : 998-TP Dept / Sect : CTB-1
Jabatan / Position : CTB Supervisor Work Location : Muara Kedang Kepala
CUTI MELAHIRKAN / MATERNITY LEAVE √ ROSTER / FIELD BREAK
: Roster
Staff Pengganti Selama Cuti / Roster : Rusman & Nur Ali

Alamat Selama Cuti : Semarang
Dari / From : 12 Februari 2019 (Tanggal Mulai Cuti / Izin - Start Leave Date)
Sampai / To : 26 Februari 2019 (Tanggal Akhir Cuti - End Leave / Permission Date)
Kembali Kerja/Return : 27 Februari 2019 (Tanggal Mulai Kerja / Start Work Date)
Asrial

HR & Adm. Dept Head
MJL-FRM-P&A37-Rev.00
:

PEMOHON - REQUESTED BY, DIKETAHUI-ACKNOWLADGE BY, DISETUJUI - APPROVED BY,

HR & Adm. Dept Head
IP-FRM-P&A37-Rev.00

Form Roster Salinan

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Form Roster Salinan

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FORMULIR PERMOHONAN CUTI / ROSTER & IZIN

ANNUAL LEAVE / ROSTER & PERMISSION APPLICATION FORM

Nama / Name : Tanggal / Date :

No. Badge/Badge No : Dept / Sect :

Jabatan / Position : Work Location :

JENIS CUTI / IZIN - Type of leave / Permission :

CUTI MELAHIRKAN / MATERNITY LEAVE ROSTER / FIELD BREAK

Staff Pengganti Selama Cuti / Roster :

Alamat Selama Cuti :

PERIODE PENGAMBILAN CUTI / IZIN - PERIOD OF LEAVE / PERMISSION

Dari / From : (Tanggal Mulai Cuti / Izin - Start Leave Date)

Sampai / To : (Tanggal Akhir Cuti - End Leave / Permission Date)

Kembali Kerja/Return : (Tanggal Mulai Kerja / Start Work Date)

Jmlh Hari- Nu. Of Working Days :

PEMOHON - REQUESTED BY, DIKETAHUI - ACKNOWLEDGE BY, DISETUJUI - APPROVED BY,

Sisa Cuti - Outstanding Balance : Diperiksa - Checked By,

Cuti Terakhir - Last Leave/Roster was on date :

Cuti Berikut - Next Leave/Roster will be on date : Mulyadi Dechia

Nama / Name : Noor Meity Safitri Tanggal / Date : 15 April 2021

No. Badge/Badge No : 1043-KKWT Dept / Sect : HSE

Jabatan / Position : Paramedic Work Location : Senyiur, KM 06

JENIS CUTI / IZIN - Type of leave / Permission :

CUTI MELAHIRKAN / MATERNITY LEAVE ✔️ ROSTER / FIELD BREAK

Staff Pengganti Selama Cuti / Roster : Hanifah

Alamat Selama Cuti : Muara Kaman, Kukar

PERIODE PENGAMBILAN CUTI / IZIN - PERIOD OF LEAVE / PERMISSION

Jmlh Hari- Nu. Of Working Days :

PEMOHON - REQUESTED BY, DIKETAHUI - ACKNOWLEDGE BY, DISETUJUI - APPROVED BY,

Sisa Cuti - Outstanding Balance : Diperiksa - Checked By,

Cuti Terakhir - Last Leave/Roster was on date :

Cuti Berikut - Next Leave/Roster will be on date : Mulyadi Dechia

Nama / Name : Purwanto Tanggal / Date : 01 November 2020

No. Badge/Badge No : 1134 - TP Dept / Sect : CTB-2

Jabatan / Position : Asst Foreman Work Location : Muara Kedang Kepala

JENIS CUTI / IZIN - Type of leave / Permission :

CUTI MELAHIRKAN / MATERNITY LEAVE √ ROSTER / FIELD BREAK

Staff Pengganti Selama Cuti / Roster : Juhairi & Edi Sesha

Alamat Selama Cuti : Mess - Jawa Tengah

PERIODE PENGAMBILAN CUTI / IZIN - PERIOD OF LEAVE / PERMISSION

Jmlh Hari- Nu. Of Working Days : 15 Hari

PEMOHON - REQUESTED BY, DIKETAHUI - ACKNOWLEDGE BY, DISETUJUI - APPROVED BY,

Sisa Cuti - Outstanding Balance : Diperiksa - Checked By,

Cuti Terakhir - Last Leave/Roster was on date :

Cuti Berikut - Next Leave/Roster will be on date : Mulyadi Dechia

Nama / Name : Tanggal / Date :

No. Badge/Badge No : Dept / Sect :

Jabatan / Position : Work Location :

JENIS CUTI / IZIN - Type of leave / Permission :

CUTI MELAHIRKAN / MATERNITY LEAVE ROSTER / FIELD BREAK

Staff Pengganti Selama Cuti / Roster :

Alamat Selama Cuti :

PERIODE PENGAMBILAN CUTI / IZIN - PERIOD OF LEAVE / PERMISSION

Dari / From : (Tanggal Mulai Cuti / Izin - Start Leave Date)

Sampai / To : (Tanggal Akhir Cuti - End Leave / Permission Date)

Kembali Kerja/Return : (Tanggal Mulai Kerja / Start Work Date)

Jmlh Hari- Nu. Of Working Days :

PEMOHON - REQUESTED BY, DIKETAHUI - ACKNOWLADGE BY, DISETUJUI - APPROVED BY,

Karyawan - Employee Atasan Langsung - Direct Superior Site Management

Sisa Cuti - Outstanding Balance : Diperiksa - Checked By,

Cuti Terakhir - Last Leave/Roster was on date :

Cuti Berikut - Next Leave/Roster will be on date : Mulyadi Dechia

Nama / Name : Tanggal / Date :

No. Badge/Badge No : Dept / Sect :

Jabatan / Position : Work Location :