Employee Name
Employee ID.
____________
Department
Contact Tel. No.
__________________________
1st Day of Leave ______________
Date Return to work___________
Address while
on Leave
Circle applicable key(s) and mention No. of days:
INDICATE TYPE OF LEAVE & DATES USING KEY*
KEY
TYPE OF LEAVE
No. of Days
Sun
Mon
Tue
Wed
Thu
Fri
Sat
AL
Annual
SAMPLE
AL 14
AL 15
AL 16
AL 17
BL 18
SL
Sick
START HERE
CL
Compassionate
ML
Maternity
HL
Haj
BL
Business
I request permission for the leave listed above. I shall comply
with the policies and procedures relating to leave that may apply.
____________________________________
___________________
________
Employee Signature
Supervisor Signature
Managing Director Signature
Date
(Endorsed by)
(Approved by)
Date of Hire _____________________
Type of Leave
Key*
Balance on
________
Annual
AL
Sick
SL
Compassionate
CL
Maternity
ML
Haj
HL
Business
BL
______________________________
Checked by
Distribution: Original: ADMIN; Duplicate: EMPLOYEE; Triplicate: EMPLOYEE DEPT. HEAD
Leave Request and Authorization Form
Please complete this section and submit to Administration Department after approval of the Department Head three weeks prior to leave:
FOR ADMINISTRATION DEPT. USE ONLY
Leave Accrued
Until Date
Leave Taken Until
Date
Leave Required
Now
Leave Balance as
on _________
FOR EMPLOYEE DEPT. USE ONLY
(RETURN TO ADMIN ONLY IF LEAVE DATES ARE DIFFERENT FROM THOSE ORIGINALLY SCHEDULED AND APPROVED)
Date Returned to work
Employee Signature
Department Head Signature
Remarks