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 cash out your paid time off at any time. However, you must have your client’s permission to use paid time off, if you will be absent durign your regular shift. Only complete forms will be processed. Unless otherwise specified, request will be processed with the next scheduled payday. If you need to be paid befor the next regular payroll, you will need to make a separate emergency payroll request.
Caregiver Name *

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

First Name Last Name
Date of Request *

Month Day Year
Date
Number of Hours Requested *
PTO HRS
I have the expression consent of my client to use PTO if use occurs during my shift. *

Yes
Signature *

Clear
Should be Empty: