ECTO CLINIC & PHARMACY

SUBJECT: LEAVE

REQUESTOR: _____________________________ POSITION: ______________________ DATE: ____________________

Please ( / ) either one:

Leave apply on / from: ______________________________ No. of Working Day(s): ______________
Leave change/cancel from: ____________ to ____________ No. of Working Day(s): ______________

Annual Leave Compassionate Leave Maternity/Paternity Leave

Medical Leave Marriage Leave Emergency Leave / Unpaid Leave

Reason for leave application : ________________________________________________________

Person to cover duties : ________________________________________________________

Requested by: Approved / Not Approved by Supervisor:

____________________________ ____________________________
Name: Name:
Date: Date:

For Human Resources Department USE Only

Leave approved for ________________ days Balance of Leave: __________ days
Period leave earned ________________ to ______________
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