BET GHg, - ge HIGHSCOPE. Bintaro INDONES! 4 Tegal Rotan Ray No. 00, Sah ara, putt, Tangerang Selatan 15413 Telp.;O21-74864640/0, Fax. 021-74864639 ABSENCE REQUEST FORM Tangerang Selatan, / / To: HR Division With this form, |: Name Date of Employment Title Employee Number/NIK Div/Dept Manager/ Director TF Came in late to school, time in , in order to, Date : SF Request for Early Dismissal, time out , Date In Order to : 7 ask permission for temporary out, in order to Date Time Out Time In Sick Leave from to * Please attach Doctor Recommendation Letter * This form must be submitted on the day of return from sick leave Absence for Personal Matter : * Teachers only or staff who doesn’t have leave quota * It must be replaced for PIC in schoo! event or deduction for salary at the end of year SF Annual Leave request, from to (Staff Only) * Must be requested for minimum two weeks before the date SF Unpaid Leave request, from to (Max. 4 weeks) * Must be requested 6 weeks before the date 7 Special Leave : (Please circle the relevent reason) A, Martiage Leave, from to (Employee/Child) B, Maternity Leave, from. to C. Paternity Leave, from. to. D. Bereavement (Husband/wife/Child/Parent/parent in-law/Family member in one house) From to E, Religious Leave (Haji-First Time Only), From. to * Must be requested two months before the date and attach the document relates F. Child Baptism/Circumcision, from to | hereby certify that all above information is true and correct Employee Sign [Approval for request : (from Manager / Director) F Approved 7 Not Approved Reason for refused (if applicable ) : Manager/Director HR Manager *page 1 for HR, copy pages for Hod/Director