PTO Request Form

PTO Request Form
Employee name:

First NameLast Name
Job title:
Today's date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Number of hours requesting off:
Number of PTO hours requesting to use:
Beginning on:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Ending on:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for request:
Other reason:
I understand that this request is subject to approval by my supervisor.
Employee signature:
Thanks for your submission. Your supervisor will review this request and contact you within 48 hours.
Should be Empty: