FORMULIR CUTI / LEAVES FORM

Nama Karyawan :
employee name
Posisi : NIK :
position name employee ID
Departemen : Tanggal Masuk :
department join date

Jenis Cuti Cuti tahunan Sisa Cuti thn 2014 Jatah Cuti thn 2014 Total Jatah Cuti (a)
type of leaves annual leave 2014 Leaves balance Leaves earn in 2014 total leaves balance
5 5

Tanggal Mulai Cuti Tanggal Akhir Cuti Total hari cuti (b)
leave start date leave end date total leave day Total leave balance (a-
21-07-2015 22-07-2015 2

Cuti lainnya sesuai Peraturan UU Ketenagakerjaan / Other leaves according to Government Regulation

Tanggal Mulai Cuti Tanggal Akhir Cuti Total hari cuti

leave start date leave end date total leave day
21-07-2015 22-07-2015 2

Cuti dibayar lainnya Alasan cuti dibayar

paid leave Reason for paid leave

Cuti tidak dibayar Cuti menjalankan ibadah haji

unpaid leave pilgrimage

Pernikahan karyawan : 3 (tiga) hari Pernikahan anak karyawan : 2 (dua) hari

marriage of employee marriage of employee's children

Suami yang Istrinya melahirkan atau

Cuti melahirkan / keguguran
maternity leave keguguran kandungan : 2 (dua) hari
husband whose wife giving birth or miscarriage

Kematian anggota keluarga, orang tua, mertua, Anggota keluarga dalam satu rumah
saudara kandung : 2 (dua) hari. meninggal dunia : 1 (satu) hari
Death of family member, parents or sibling death of one of the house member

Khitanan/baptisan anak : 2 (dua) hari.

circumcision/baptis
* hanya hitung hari kerja tanpa sabtu/minggu dan hari libur nasional/ only calculate weekdays without weekend and holliday

Alamat selama cuti :

address during leave

Nomor Telepon :
Telephone Number

Proposed by Approved by Acknowledged by Received by HRD

Employee Name Direct Manager Director
RM

Sisa hari cuti (a-b)

Total leave balance (a-b)
3

ng to Government Regulation

alankan ibadah haji

n anak karyawan : 2 (dua) hari

mployee's children

g Istrinya melahirkan atau

kandungan : 2 (dua) hari
se wife giving birth or miscarriage

eluarga dalam satu rumah

dunia : 1 (satu) hari
of the house member
weekend and holliday