PTO PAY REQUEST WITH TIME OFF
To be filled out by Supervisor or Manager ONLY
The employee PTO policy can be found in the employee handbook.
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Employee Name *
Department Code *
Date of Request *
DD
/
MM
/
AAAA
How Many PTO Hours Requested? *
From: *
First Day Off
DD
/
MM
/
AAAA
To: *
Last Day Off
DD
/
MM
/
AAAA
Return: *
Day Returning To Work
DD
/
MM
/
AAAA
How Many Hours Do You Work Per Week? *
Who Will Be Covering (performing work) *
Comments:
Supervisor or Manager you report to *
Your Name
Supervisor you report to Email Address *
Your email address. You will receive a copy of this request.
Manager you report to Email Address *
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