Time Off Request NJ3

Time Off Request | PTO Hours

This form is to be used for all Unpaid (UTO) and Paid Time Off (PTO)
Associate Name:*

First NameLast Name
Site Location*
Email*
example@example.com
Employee #:*
Department | Position*
Shift Schedule*
Type of Request*
Note: PTO will not be paid unless requested. Please let us know how much you are requesting to use - PTO availability is on your Paystub.
Paid Time Off or Unpaid Time Off (please select one)*

Paid Time OffUnpaid Time Off
How many hours of Paid Time Off would you like to use?*
Request Start Date*

MonthDayYear
Return To Work Date*

MonthDayYear
Number of Days*
Reason for Request*
Employee Signature: By signing below, I acknowledge I understand that time away from work is subject to: IntelliSource management approval, company policies, and business needs.*
Should be Empty: