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Contoh Form Cuti

The request for leave form collects information about the employee such as name, department, social security number and contact information during leave. It requests information about the type of leave being requested (paid, unpaid), reason for leave (vacation, illness of family member or self, care for new child), dates of leave and any special circumstances. The employee signature is required. The medical leave form collects similar employee information but focuses on details of the medical leave such as reason, number of days requested, who will cover responsibilities and whether leave has been taken previously. Signatures of the employee and department are collected with effective leave and return dates.

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jvaj ren
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232 views2 pages

Contoh Form Cuti

The request for leave form collects information about the employee such as name, department, social security number and contact information during leave. It requests information about the type of leave being requested (paid, unpaid), reason for leave (vacation, illness of family member or self, care for new child), dates of leave and any special circumstances. The employee signature is required. The medical leave form collects similar employee information but focuses on details of the medical leave such as reason, number of days requested, who will cover responsibilities and whether leave has been taken previously. Signatures of the employee and department are collected with effective leave and return dates.

Uploaded by

jvaj ren
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sample Request for Leave Form

Employee Name: ______________________________

Department: __________________________________

Social Security Number: _________________________

Date of Request: _______________________________

Leave Category Requested


_____ Paid Leave
_____ Unpaid Leave
_____ Other (Explain:____________)

Reason for Leave


_____ Vacation/Personal Leave
_____ Ill Family Member (Relationship_____________)
_____ Employee's Own Illness
_____ Care for New Child
_____ Other (Explain:____________)

Beginning Date of Leave: __________________________

Ending Date of Leave: ____________________________

Address During Leave: ____________________________

Phone No. During Leave: __________________________

Employee Signature: _____________________________

Special Circumstances (Explain):


___________________________________________________________________________
___
___________________________________________________________________________
___ ______________________________________________________________________

Sample Medical leave form:

 Leave form number: ___________


 Date of filling the form: ___/____/___
 Employee information:
Name: ________________________________

Street Address: ___________, city: ______________, state: ____________, PIN:


____________-

Phone Number: _______________

 Medical leave details:

What is the reason behind this medical leave: _____________?

How many days of medical leave do you wish to apply for: ___________

___________________

Who will be the next respondent to your job duties: ______________________?

Have you already availed any medical leave: _________________________________?

If yes, please mention the days: ______________________________________

 Signature of the employee: _______________________


 Signature of the concerned department: ____________
 Effective date of leave: ____/____/____                    Reporting Date: ___/___/___

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