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Mitra Hospital Leave Request Form

The document is a Leave Request Form for employees at Mitra Emergency Hospital. It requires employees to provide personal details, the reason for leave, and signatures from both the employee and supervisor/manager. The form also includes sections for approval status and whether the leave is paid or unpaid.

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sanjeev
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5 views1 page

Mitra Hospital Leave Request Form

The document is a Leave Request Form for employees at Mitra Emergency Hospital. It requires employees to provide personal details, the reason for leave, and signatures from both the employee and supervisor/manager. The form also includes sections for approval status and whether the leave is paid or unpaid.

Uploaded by

sanjeev
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

Mitra Emergency

Hospital

Leave Request Form

Employee to Complete
Employee Name: ………………………………………… Employee Number : …………………………………………….

Department: ……………………………………………. Position: …………………………………………….

Supervisor/Manager: …………………………………………….

Reliever Name : ………………………………………………… Reliever Signature :

…………………………………………

Status (select one)  Full-time  Part-time

I hereby request a leave of absence effective on / / (date you are requesting leave to commence).

I expect to return to work on


/ /

Reason for Requested Leave


Reason

Employee Signature Date / /

Employer to Complete
 Leave Approved

 Leave Denied
Reason

Leave is  Paid  Unpaid (select one)

Supervisor/Manager Signature Date / /

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