BMDS LEAVE OF ABSENCE FORM

**Note: Ensure accurate details are entered, as this form will be automatically forwarded to our client(s).

CLIENT INFORMATION

Client's Company Name *

Client's Email *

**Note: If you are working under a direct supervisor other than the client, please provide the relevant details below so that they will be included when we send this Leave Form, otherwise, LEAVE the fields blank.

Name of DA POC (your direct supervisor other than the Client)

DA POC Email Address (1 email only) Do not enter the Client's email if you typed it above.

DA INFORMATION

First Name *

Last Name *

Your Email Address (use your Bottleneck email address if you have one) *

Position or Job Title *

Work Hours (Your work hours in US time zone ) *

LEAVE INFORMATION

**Note: If your leave covers non-consecutive dates within the month, kindly fill out a separate LOA.

Leave Dates *

Return Date *

Total Leave Duration *

Reason for Leave/Absence *

Is this a paid leave? *

Yes

Leave Status *

Approved

Not Approved

Who approved your leave? *

Type of Leave *

Holiday

Vacation

Emergency

Sick Leave

Routine Tasks *

To whom did you delegate your tasks? What is expected of this person when doing your tasks? *

*Reminder:
It is mandatory to inform and notify the HR Team about your leave. Please email [email protected]