LEAVE APPLICATION FORM LEAVE APPLICATION FORM

Instruction: 1. Application for Vacation leave should be filed 5 days before the Inclusive date Instruction: 1. Application for Vacation leave should be filed 5 days before the Inclusive date
2. Application for Sick leave shall be filed upon return to work. 2. Application for Sick leave shall be filed upon return to work.
3. Application for Sick leave filed in advance, or exceeding five (5) days shall be accompanied by a medical certificate. 3. Application for Sick leave filed in advance, or exceeding five (5) days shall be accompanied by a medical certificate.

Employee Name : Employee Name :

Designation : Designation :
Date of Filing : Date of Filing :

Type of Leave Inclusive date: Type of Leave Inclusive date:

Vacation Vacation
Sick Sick
Maternity No. of Working days Applied for: Maternity No. of Working days Applied for:
Others(please specify) Others(please specify)

Reason(s): Reason(s):

Employee's Signature Employee's Signature

Signature over Printed Name Signature over Printed Name

Details of Action on Application Details of Action on Application

Please see computation at the back of the form Please see computation at the back of the form
Certification of Leave Credits as of: Approved Certification of Leave Credits as of: Approved
Disapproved due to Disapproved due to

Vacation Sick Total Vacation Sick Total

With Pay With Pay
Without Pay Without Pay
Date employed: Date employed:

JESSA MAY D. TRESTIZA DANN GILFORD A. MONTANO JESSA MAY D. TRESTIZA DANN GILFORD A. MONTANO
Human Resource Officer President/General Manager Human Resource Officer President/General Manager