Employee Name: HR ID:
Department: Division Platform Department Manager:
________________________________________________________________________
PLEASE SUBMIT THE APPROVED LEAVE APPLICATION TO HR (original copy)
ANNUAL VACATION PLEASE CHECK THE APPROPRIATE BOX(ONE BOX ONLY)
Employee record update
Current Year Entitlement (a) Days
Last Year Accrual (b) Days
YTD Days Taken (c) Days
Balance to Go (d) Days
Note: a+b-c=d
SICK/SICKNESS DISABILITY LEAVE Pls. Attach Doctor’s certificate &
Doctor’s Diagnoses Book
MARRIAGE LEAVE
MATERNITY/FRATERNITY Pls. Attach doctor’s certificate
COMPASSIONATE LEAVE
UNPAID LEAVE
NURSING LEAVE
Remarks
OTHER TIME OFF WITHOUT PAY: Pls. Specify Reason:
________________________________________________________________________
DURATION:
Total:____________________________________________________________________
EMPLOYEE SIGNATURE : Rachel Huang DATE:
DEPARTMENT MANAGER SIGNATURE DATE
HUMAN RESOURCES USE ONLY:
Days actually taken this time_________________(if applicable)
Payroll action taken (if applicable)
