Employee Name:　　HR ID:

　　Department: Division Platform　　Department Manager:

　　________________________________________________________________________

　　PLEASE SUBMIT THE APPROVED LEAVE APPLICATION TO HR (original copy)

　　ANNUAL VACATION　　PLEASE CHECK THE APPROPRIATE BOX(ONE BOX ONLY)

　　Employee record update

　　Current Year Entitlement (a) Days

　　Last Year Accrual (b) Days

　　YTD Days Taken (c) Days

　　Balance to Go (d) Days

　　*Note: a+b-c=d

　　SICK/SICKNESS DISABILITY LEAVE Pls. Attach Doctor’s certificate &

　　Doctor’s Diagnoses Book

　　MARRIAGE LEAVE

　　MATERNITY/FRATERNITY Pls. Attach doctor’s certificate

　　COMPASSIONATE LEAVE

　　UNPAID LEAVE

　　NURSING LEAVE

　　Remarks

　　OTHER TIME OFF WITHOUT PAY:　　Pls. Specify Reason:

　　________________________________________________________________________

　　DURATION:

　　Total:____________________________________________________________________

　　EMPLOYEE SIGNATURE : Rachel Huang　　DATE:

　　DEPARTMENT MANAGER SIGNATURE　　DATE

　　HUMAN RESOURCES USE ONLY:

　　Days actually taken this time_________________(if applicable)

　　Payroll action taken (if applicable)