Certified By: Approved By: Checked By: Requested by
Certified By: Approved By: Checked By: Requested by
2018
NAME:________________________________________________ DEPARTMENT:______________________________________________
REASON:______________________________________________ DATE FILE:___________________DATE LEAVE:____________________
_____________________________________________________ REGULAR ( )
EHP ( )
TYPE OF REQUEST:
( ) VACATION LEAVE ( ) SICK LEAVE ( ) BEAREVEMENT LEAVE
( ) LEAVE W/O PAY ( ) MATERNITY LEAVE ( ) OTHERS: (PLEASE SPECIFY) ______________________
( ) BIRTHDAY LEAVE ( ) CALAMITY LEAVE ________________________________________________