LEAVE REQUEST FORM LEAVE REQUEST FORM

Date File: ___________________ Date File: ___________________

Name: __________________________________________________ Name: __________________________________________________

Position: ________________________________________________ Position: ________________________________________________
Company & Department: ___________________________________ Company & Department: ___________________________________

Date Date
Requested: from: ________________ to: ________________ Requested: from: ________________ to: ________________

Type of requested Leave: (pls. check appropriate line) Type of requested Leave: (pls. check appropriate line)
____ Vacation Leave ____ Half Day Leave ____ Vacation Leave ____ Half Day Leave
____ Sick Leave ____ Unpaid Half Day Leave ____ Sick Leave ____ Unpaid Half Day Leave
____ Unpaid Vacation Leave ____ Bereavement Leave ____ Unpaid Vacation Leave ____ Bereavement Leave
____ Unpaid Sick Leave ____ Maternity/Paternity Leave ____ Unpaid Sick Leave ____ Maternity/Paternity Leave
REASON FOR LEAVE: REASON FOR LEAVE:
_________________________________________________________ _________________________________________________________
_________________________________________________________ _________________________________________________________
_________________________________________________________ _________________________________________________________

Requested By: Approved By: Requested By: Approved By:

______________________ ______________________ ______________________ ______________________

Employee’s Name Department Head and/or HR/Admin Employee’s Name Department Head and/or HR/Admin
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name

HRD Form No. 001 HRD Form No. 001

(Revised, March 12, 2024) (Revised, March 12, 2024)

LEAVE REQUEST FORM LEAVE REQUEST FORM

Date File: ___________________ Date File: ___________________

Name: __________________________________________________ Name: __________________________________________________

Position: ________________________________________________ Position: ________________________________________________
Company & Department: ___________________________________ Company & Department: ___________________________________

Date Date
Requested: from: ________________ to: ________________ Requested: from: ________________ to: ________________

Type of requested Leave: (pls. check appropriate line) Type of requested Leave: (pls. check appropriate line)
____ Vacation Leave ____ Half Day Leave ____ Vacation Leave ____ Half Day Leave
____ Sick Leave ____ Unpaid Half Day Leave ____ Sick Leave ____ Unpaid Half Day Leave
____ Unpaid Vacation Leave ____ Bereavement Leave ____ Unpaid Vacation Leave ____ Bereavement Leave
____ Unpaid Sick Leave ____ Maternity/Paternity Leave ____ Unpaid Sick Leave ____ Maternity/Paternity Leave
REASON FOR LEAVE: REASON FOR LEAVE:
_________________________________________________________ _________________________________________________________
_________________________________________________________ _________________________________________________________
_________________________________________________________ _________________________________________________________

Requested By: Approved By: Requested By: Approved By:

______________________ ______________________ ______________________ ______________________

Employee’s Name Department Head and/or HR/Admin Employee’s Name Department Head and/or HR/Admin
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name

HRD Form No. 001 HRD Form No. 001

(Revised, March 12, 2024) (Revised, March 12, 2024)