<Insert Company Name>
LEAVE APPLICATION FORM
Date:
Employee Name:
Employee Code:
Department:
Leave Details :
Number of Days (including Saturday &
Sunday):
From:
To:
If half day
Morning:
Afternoon:
Type of Leave :
Reason for requesting leave:
Contact Address during leave period:
Phone Number:
Date :
Signature of Employee
Leave sanctioned as follows (To be filled in by Supervisor)
No leave sanctioned:
Supervisors Signature and Date
Reason for not sanctioning leave:
Department Heads Signature and Date
Leave adjusted against Balance (For HR and Finance)
Leave without pay (to be adjusted in
payroll):
Human Resource Representative and
date
Finance Representative and date (if LWP)