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Molex Intergrated Products Philippines, Inc.

TECO – Special Economic Zone 3, Brgy. Bundagul, Mabalacat, Pampanga


Tel. #: 045-455-9800

LEAVE FORM
Employee Name: _______________________
SAP #: _______________________
Department: _______________________
Date Filed: _______________________

Type of Leave From To Total Reason


Sick Leave
Vacation Leave
Emergency Leave
Maternity Leave
Paternity Leave
Others, pls specify

Please check if:


With Pay
Without Pay

Requestor/Date Supervisor/Date Processes by/Date

For HR use only


Remaining Credits Remarks
Sick Leave
Vacation Leave

(EFFECTIVE DATE

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