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Human Resources Department
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Employee Request Form
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No. _____________________________
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Requested by :DepartmentUnit
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Position Title:
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 New Hire
Replacement
Internship
Part Time
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If Replacement:
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Replacing (Employee Name)
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Last Working Date:
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Reason:Resigned TerminatedInternal TransferOther
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Justification
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Why is this position needed?
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What happens if this position is not filled?
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Current workload condition?
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Position Details
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Total headcount
1 Replacement and 3 New Hire (example)
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Position Title:
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Reporting to:
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Salary:
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Urgency
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Target Join date:
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Urgency Level:
Normal (30 - 60 Days)
Urgent (30 Days)
Critical (Service distruption)
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 Approval
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Executive Operations Manager Human Resources Department Operations Director
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SignatureSignatureSignature
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Ns. I Gede Darma Arnaya, S.Kep.Ni Komang Sinta Tri Utamidr Rosalia Puspita Jaya
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Date;Date;Date;
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Requestor
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Original : Human Resources
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Copy 1 : Department Concerned.
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Employee Name
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Date;
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