Paid Time Off Request Form

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Paid Time Off Request Form
Temporary employees are eligible for paid vacation after accumulating 2000 continuous hours from their start date with Clear
Choice Staffing Solutions. The allotted number of paid days for the vacation time is five (5). The terms and conditions are as
follows:
1.
The employee must work a total of 2000 continuous hours from start date with Clear Choice Staffing Solutions.
2.
Continuous is defined as constant; an employee that is on one assignment for all of the 2000 hours total.
3.
Vacation time may be taken in increments of one full day but in all cases must be prescheduled and preapproved with
both Clear Choice Staffing Solutions and by their Supervisor at the client location.
4.
Vacation pay is the employee's regular rate of pay, excluding overtime or holiday premiums.
5.
When employment ends for any reason, vacation time earned but not taken will not be paid to the employee.
Employee:________________________________________________
Employee Number:_________________________________________
Department:_______________________________________________
Supervisor:_______________________________________________
Please List the Vacation Dates you are requesting (mm/dd/yy):
Employee Signature__________________________________________
Date_________________________
Manager Signature___________________________________________
Date_________________________

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