Paid Time off Request (PTO Form)

Paid Time off Request (PTO Form)
Making a Paid Time Off request
INSTRUCTIONS

Complete this form to request paid time off. You can also use this form to request to "cash out" your PTO. If you are taking time off of work, you must have your client’s permission to use paid time off so that they can schedule appropriately. Only complete forms will be processed. Requests will be processed with the next scheduled payday.

NOTE: You can view your PTO Balance on your Checkstub or the Paylocity Portal.
Caregiver Name*

First NameLast Name
Caregiver Email
example@example.com
Client Name*

First NameLast Name
Date of Request*

MonthDayYear
Date
Number of Hours Requested*
PTO HRS (View Available Balance on your Checkstub)
I have the expression consent of my client to use PTO if use occurs during my shift.*

Yes
Signature*

Clear
Should be Empty: