Sick Leave Form

June 27, 2011

Employees need to fill in a sick leave application whenever the need for one arises. This is important for the hr to maintain the records of employees and also to account for the days the employee is absent from work. The form is normally presented by the hr department. Below is a sample sick leave form.

Sample Sick Leave Form

Employee Name ______________________

PERSAL Number _____________________

Address during leave ___________________

Phone no during leave __________________

Department ___________________________

Sick leave Start date                    End date                            Number of working days

________________________    ____________________   _____________________

________________________    ____________________   _____________________

Specify illness ______________________

Employee signature ____________________ Date ________________

Supervisor Recommendation

Recommended ___________ Not recommended ________________ Rescheduled _____

Remarks ________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Supervisor signature ________________________ Date _____________________

Departmental Head Approval

Approved with full pay _________ Approved without pay ______ Not Approved ______

Remarks ________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Departmental head signature ______________________ Date _____________________

Captured by __________________________ Date ___________

 

Download Sick Leave Form in Word Format

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