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LEAVE APPLICATION FORM

LEAVE REQUEST LEAVE REVOKED

PLEASE SUBMIT 2 (TWO) WEEKS BEFORE YOUR LEAVE


DATE OF APPLICATION
FULL NAME : Rika Purnama Sari
POSITION : Perawat Swab dan MCU 27 April 2023
DEPT / AREA : Bumame Hublife

LEAVE PERIOD
FROM TO TOTAL

28 April 2023 29 April 2023 2 Hari

TYPE OF LEAVE FOR EMERGENCY PURPOSES DURING LEAVE


ANNUAL LEAVE Contact Person (Peers or subordinates):
MATERNITY
085817127532 (Suami)
LEAVE MARRIAGE
NO PAY LEAVE
OTHER …………………

Current Leave Balance HRM Leave Plan


Current Year Leave : days Leave Entitlement : days
Carried Forward Leave : days Leave Request : days
Leave Taken : days Leave Permitted : days
Leave Revoked : days
Total Balance : days Total Balance : days

Notes :

APPLICANT'S SIGNATURE SPV & MANAGER'S SIGNATURE HUMAN RECOURCES MANAGER


APPROVED / REJECTED ACKNOWLEDGE

NAME : Rika Purnama Sari NAME : Ferry Cornelius NAME :


DATE : 24 April 2023 DATE : 24 April 2023 DATE :

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