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EMPLOYEE'S LEAVE FORM

Name of Employee : Ethel Gretchen A. Casalla Date Filed: 12/11/17


Position :Nurse Employee No._________
Clinic/Department :Alorica Northgate
Aventus
TYPE OF LEAVE
Vacation Leave Emergency Leave Solo Parent Leave Others

Sick Leave Maternity Leave Paternity Leave Pls. specify:

Period of Leave Covered: 18-Dec-17 1 Total No. of Day


Reason[s]: ___________________________________________________________________________________________

TO BE FILLED UP BY HRDO

Total No. of Leave Credits:____________ Available Balance:__________ Days Applied:__________ Days Balanced:_________
Leave with Pay Leave w/o Pay

Approved by: Received by:

Ethel Gretchen A. Casalla __________________________


Employee's Signature Over Printed Name Immediate Supervisor/Department Head HRDD

cc:Employee/HRDO

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