APPLICATION FOR LEAVE OF ABSENCE

Name: Date Filed: ____________________

Department: __________________________________
Position: ______________________________________

Nature of Leave:
Vacation Leave Maternity Leave Authorized Leave w/o Pay
Sick Leave Emergency Leave Under time Leave
Official Business No Punch In/Out Offsetting

From: __________________________________ To:______________________________ No. of Days______________ Day/s off_____________

(Date) (Date)

Date: __________________________ From: _____________________ To: ____________________ No. of Hours___________ (Under time)

Reason: (Attach Certificate to Support your request) : ____________________________________________________________________

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Offsetting

Date of offset Date of Covered Date of Offset Date of Covered

Note: Have your LEAVE signed by your department head first before your immediate supervisor.
Approval

Approved Disapproved

_____________________ _______________________ _______________________

Employee’s Signature Department Head Immediate Supervisor