Management – Paid Time Off Request

Salaried and Hourly Management - Paid Time Off Request

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Form filled out Date and time
Employee Information
First Name*
Last Name*
Email*
Request for the following hours off (Paid Time Off, PTO):
Date*
Please enter the first day of PTO this request is being submitted for.
MM slash DD slash YYYY
Hours Requested*
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Reason for PTO Request*
Would you like to request an additional day(s)?
- Yes
Section Break
Additional Days
Date (2)*
Please enter additional day requested (Day 2)
MM slash DD slash YYYY
Hours Requested - Day 2*
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Date (3)
Please enter additional day requested (Day 3)
MM slash DD slash YYYY
Hours Requested - Day 3
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Date (4)
Please enter additional day requested (Day 4)
MM slash DD slash YYYY
Hours Requested - Day 4
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Date (5)
Please enter additional day requested (Day 5)
MM slash DD slash YYYY
Hours Requested - Day 5
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Date (6)
Please enter additional day requested (Day 6)
MM slash DD slash YYYY
Hours Requested - Day 6
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Date (7)
Please enter additional day requested (Day 7)
MM slash DD slash YYYY
Hours Requested - Day 7
PTO must be taken in 4 hour increments, please speak directly with your supervisor if you are requesting an amount less than 4 hours. Similarly, if you are requesting unpaid time off please speak with your supervisor to ensure the time is properly accounted for.
Section Break
Total number of PTO Hours requested*
Please enter the total hours of PTO requested above.
Date Returning to Work*
Please enter the date you expect to return to work.
MM slash DD slash YYYY
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