Leave Request Form Employee Information Name :1.__________ Employee Number :2.__________ Department :3.__________ Leave Type :4.__________ Starting Date :5.__________ Resumption Date : January 25 th ,2016 Reason for Leave : I have been feeling uncomfortable 6. _________ few weeks, but I was 7.__________ trip in other places, so I didn ’ t have enough time to see a doctor. When I came back, I finally got the time and came to 8.__________ as soon as possible. According to the doctor, it is 9.__________ and urgent for me to be hospitalized to get further check and treatment. So I have to take a sick leave for two weeks. Signature of Applicant :10.__________ Please fill in the blanks with the following words or phrases: 1.January 10th,2016 2.on a business 3.Li Jun 4.see a doctor 5.Li Jun 6.in the past 7.suggest 8. on a business trip 9.Marketing Department 10.necessary 11.120485 12. Sick Leave