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PERMOHONAN CUTI KARYAWAN

(On Leave Request Form)


NAMA
(Name)
Tgl. MulaiBekerja
(Date of Joining LSPR)
Jabatan / Lokasi
(Position / Division)
Alamat/Telepon (SelamaCuti) (Address / Phone
Number while on Leave)

JumlahHariCuti HariKerja MulaiTgl.


(Total Days for Leave of (Week Days) (Date)
Absence) Sampai Tgl
(Date)

JenisCuti CutiTahunan CutiSakit


(Type of Leave) (Annual Leave) (Medical Leave)
CutiTanpaBayaran CutiKhusus/Lain-lain
(Unpaid Leave) (Others)

Tgl. Permohonan
(Date of Application)

Pemohon,
(Applicant)

(- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -)

Menyetujui(Approved by)
AtasanLangsung, GM/Programme Director, Direktur:
(Supervisor) (CEO)

(- - - - - - - - - - - - - - - - - - - - - -) (- - - - - - - - - - - - - - - - - -) (Prita Kemal Gani)

Catatan Administrasi HRD (HR Purposes Only) Keterangan (Remark)

SisaCutiTahunLalu Hari
(Total Leave Last Year) (Days)
Total CutiTahunIni Hari
(Total Leave This Year) (Days)
Cuti Yang TelahDigunakan Hari
(Leave That Has Been Used) (Days)
SisaCuti Hari
(Remaining Leave This Year) (Days)

DiketahuiOleh (Acknowledge by)


Head of HRD, Training & Dev. Manager,

(- - - - - - - - - - - - - - - - - - - - - -) (- - - - - - - - - - - - - - - - - - - - - -)
*Training & Dev. Manager for Expat Only

Cn: hrd/f-ck/02/ikb/3/2020/00

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