Personal Time Off Request Form

Time Off Request

Request a time off from work
Employee Name

First NameLast Name
E-mail
Are you requesting to use PTO for an unplanned absence:
Unplanned Absence Date:

MonthDayYear
Are you requesting full days off:
Dates Requested:
Return to work on

MonthDayYear
Will You be leaving Early or Coming in Late:
Select Which One
If leaving early what time do you need to leave:
If coming in late what time do you plan to come in:
Reason
Additional Comments
Would you like to utilize Available PTO?
# of PTO Hours Requesting To Be Used (If remaining)
Signature
Should be Empty: