LEAVE APPLICATION FORM
1. FOR APPLICANT USE:-
Employee # Division: Location:
NAME: _______________________________
DESIGNATION:_________________________
TYPE OF LEAVE NO. OF DAYS ADDRESS DURING REASON FOR LEAVE
REQUESTED REQUESTED LONG LEAVE
CASUAL [ ] DAYS:
SICK [ ] FROM DATE:
EARNED [ ] TO SIGNATURE:
LEAVE W/O PAY
[ ]
2. FOR USE BY APPLICANT'S DIVISION:-
[ ] RECOMMENDED [ ] NOT RECOMMENDED [ ] APPROVED [ ] NOT APPROVED
REASON: _______________________________ TYPE OF LEAVE : __________
_______________________________________ No. of Days: __________
DATE: DATE:
LINE MANAGER HEAD OF DIVISION
3. FOR USE BY HR DIVISION:-
LEAVE AVAILABLE (IN DAYS) LEAVE RECORD INCHARGE
CASUAL SICK (SIGNATURE):
EARNED/UNPAI
D
DATE OF ENTRY:
LEAVE APPROVED (IN DAYS) HEAD OF HR:
CASUAL SICK (SIGNATURE):
EARNED/UNPAI
D
DATE:
IF EARNED LEAVE: L.F.A. AMOUNT Tk. _________________________________(in words)
ANY ADDITIONAL COMMENTS OR REMARKS:
___________________________________________________________________________
___________________________________________________________________________
SIGNATURE: _______________________ DATE: _______________________
Note: Original copy to be placed in Personal file, photocopy to be retained by the Employee.