Pto Request Form printable pdf download

Pto Request Form

PTO REQUEST FORM

Requests for scheduled days off with pay as provided in the company PTO policy are to be

submitted for approval before taking that time off. Days used when off for an unscheduled day

(illness or personal injury) are to be submitted to the office or manager the first day back to

work. PTO days will NOT be carried over to the next year.

PTO – SCHEDULED Day-Off Request

Date From:___________________

Date To: ___________________ Total Days:________

Print Name:__________________________________________

Signature:___________________________________________

Date:__________________

Supervisor/Manager Signature:___________________________________________________

Supervisor approval and signature is required for PTO to be granted.

PTO – UNSCHEDULED Day-Off Request

Date Off From: ___________________ To: ___________________

Total Days:________

Print Name:__________________________________________

Signature:___________________________________________

Date:__________________

PTO SUMMARY

FT Hire/Anniversary Date:___________________

# Days Used:___________

# Days PTO granted current Year:_____________

# Days Left:____________

________ Days NOT Used. Request paid at first pay period after my anniversary date.

DAYS NOT TAKEN MUST BE SUBMITTED FOR PAY WITHIN 30 DAYS OF FT ANNIVERSARY DATE

__________________________________

Printed Name

___________________________________

________________________

Signature

Date

Pto Request Form