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Employee surname Employee start dateEmployee nameRegistry No.
 Working period for one year, the number of days not worked in it and the reasons
YearThe date on which the leave entitlement was earned one year ago     SickMilitaryState of necessity           AbsenteeismInterruption of service           Other causesDate of entitlement to leave           Seniority in workplaceLeave PeriodRoad leaveLeave Start DateReturn DateSignature of Employee