PT.

Prismas Jamintara PRISMAS

Sona Topas Tower, 5A Floor Recruiting Good People

Jl. Jend. Sudirman Kav. 26

Jakarta 12920
LEAVE APPLICATION FORM

Name :
Position :
Department :
Date joined the company :

Period
Type Of Leave Remaks
From To Total
Annual Leave
Special Leave
Other

FOR EMERGENCY PURPOSES (Contact addressduring leave)

Name :
Adress :

Phone :

FOR RELIEF PURPOSE

(Please identify the person incharge of your job while you are away)
Name :
Position :
Approved :

TO BE COMPLETED BY EMPLOYEE
Leave Entitlement : days
Leave Already Taken : days
Balance : days
Leave To Be Taken : days
Total Balance :

Date: Date : Date :

Head HRD Department Administration Koordinator Employee's:
Approved : Approved :

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