Pto Request Form printable pdf download

Pto Request Form

PTO Request

Request must be submitted to your Manager 2 weeks PRIOR to first date of requested time off,

then forwarded to Human Resources for verification of PTO hours.

Employee Name:

Date Submitted:

Dates Requested:

Day of Week

Date

PTO

Hours

Unpaid

Current Accrued PTO Hours

-Less Hours Previously Taken

Monday

Tuesday

Wednesday

Thursday

Friday

Requested PTO Hours

Remaining PTO Hours

Note:

•

A full day of PTO for salaried, exempt employees is 9 hours, with Fridays counting as 4 hours.

•

PTO should only be requested in increments of half days (4 hours) or greater.

•

Bereavement pay is for employees who have had a death in their immediate family which allows up to 3 days

of paid time off. See handbook for more information.

Comments:

_________________________________

Employee:

FOR PAYROLL USE ONLY:

Signature

_________________________________

Reviewed:

_________ Date Entered

Human Resources

_________ Initials

:_________________________________

Approved

Manager

Jobs/2017 Human Resources/PTO/PTO Request Form

Pto Request Form