Paid Time off Request (PTO Form)

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

PCA Paid Time Off (PTO) Request Instructions

Use this form to request paid time off or to cash out your accrued PTO. If you're requesting time off, you must first obtain approval from your client to ensure proper scheduling. Only fully completed forms will be accepted.

To receive payment on the upcoming payday, submit your request no later than Thursday at 5:00 PM (Week 2) prior to 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 expressed consent of my client to use PTO if use occurs during my shift.*

Yes
Signature*

Clear
Should be Empty: