Leave of absence

Special Security Services Ltd

Leave Of Absense form
This form should be completed if:

Leave of absence is applicable where the one (1) day personal leave will not suffice and the purpose does not apply to any of the other available forms.
Name

First NameMiddle NameLast Name
Cellphone #

Area CodePhone Number
Home phone #

Area CodePhone Number
Whatsapp #

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Benefits #
Social Security #
Department/Location
Number of days applying for
Travelling overseas
If yes, intended address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date requested from

DayMonthYear
Date
Date requested to

DayMonthYear
Date
Resume work on

DayMonthYear
Date
Purpose of Leave
Relieving officer(s):
Employee’s Signature
Date

MonthDayYear
Date
Date

MonthDayYear
DateHourMinutesAM/PM Option
Scheduling Agent Remarks
Date

MonthDayYear
DateHourMinutesAM/PM Option
Operations Manager remarks
Operations Manager's signature.
Date received

MonthDayYear
Date
Approved by Human Resource manager
Human Resources Manager remarks
Human Resources Manager Signature
Date

MonthDayYear
Date
Reviewed by
Remarks
Signature
Should be Empty:

Special Security Services Ltd