Leave Application

Employee Name:

Date Filed:

Date Hired:

Signature:

Dep't/Position:

Employee No.:

(Please Check One)

Daily Paid

Monthly Paid

Vacation Leave

Sick Leave

Maternity Leave

No. of days:

Date: from to

Time: from to

Reason:

Noted (Attached Medical Certificate of Sick Leave)

Noted By:

Supervisor

Dep't Manager / Plant Manager

General Manager