LEAVE OF ABSENCE REQUEST

PART 1 (This part to be completed by Applicant)

Employee:
E
Employee ID:

M Contact #:

P Department:

Designation:
L
Reason For Leave of Absence:
0 Initial Application Annual Leave Unpaid Leave Maternity Urgent Leave
Vacation Leave Compassionate Paternity Overseas Business Trip
Y Amendment Sick Leave Examination Reservist
(Specify date of last LOA request to be Birthday Leave Marriage In-Camp Reporting
Amended.) Other (specify):__________________________
E
Requested start date:
E
Anticipated return date:

Employee's signature: Date: Phone:

APPROVAL/DENIAL OF LEAVE REQUEST

MM/DD/YY MM/DD/YY
Your requested leave is approved and Begins on ___________________ and ends on ___________________
___/___ days/weeks.

E
Other Leaves
Your requested leave is not approved for the following reason(s):
M

L
PART III (This part is to be completed by HR & Admin)
0
Applicant's Name :
Y
Applicant's Last Leave Balance Less Leave Applied On New Leave Balance
E

Supervisor's signature: Date: Mobile #:

Department head's signature: Date: Mobile #: