Personal Time Off (Pto) Request

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Personal Time Off (PTO) Request
________________________________
_____________________
_____________________
Employee Name
Company Name
Today’s Date
________________________________
_____________________
_____________________
Position
Branch Office
Signature
*
Reason For Leave
________________________________________________________________________
Specify weekday, date, shift and total number of hours requested:
Example:
Monday
3/1/10
12pm-3pm
3 hours
Day 1: ___________________
____________
__________________
_________
Day 2: ___________________
____________
__________________
_________
Day 3: ___________________
____________
__________________
_________
------------------ OR ------------------
Complete the following if you are requesting more than three consecutive days:
From: _____________ To: _____________ Total Days: ______ Will return to work on: __________
For Salaried or Full-Time Administrative Employees Only
If available, deduct the requested time off from:
Vacation Time
OR
Sick Time
Obtain signature of employee(s) who will cover your duties. You may leave this area blank, if you are
completing this form after you have returned from your time off of work.
________________________________
_____________________
____________
Name of Employee that will cover duties
Signature
Date
________________________________
_____________________
____________
Name of Employee that will cover duties
Signature
Date
APPROVED BY:
The requested time off will be considered unauthorized if not approved by your supervisor,
which may be grounds for Disciplinary Action. Refer to the Employee Handbook for details.
________________________________
_____________________
____________
Supervisor Name (print)
Signature
Date
For HR Department only
________________________________________
_______________________________
__________________
Print Name
Signature
Date
Comments:______________________________________________________________________________________________________
*Attach a doctor’s note for medical or disability time off.
B
O
RANCH
FFICES
Alhambra ♦ Camarillo ♦ Monterey Park ♦ Palmdale ♦ Riverside ♦ San Luis Obispo ♦ Santa Clarita ♦ Santa Maria ♦ Van Nuys

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