Vacation Time Off Request Form

Time Off Request
*** Employees are responsible for ensuring they have the paid days requested available and verifying the accuracy of remaining PTO (Paid Time Off) on their paychecks. Employees should contact Theresa Frazier if their paycheck does not accurately reflect their remaining PTO. If the employee does not have remaining PTO the time will be unpaid.
Employee Name*
First Name
Last Name
Email*
Enter your email to receive confirmation of approval
Date From:*

MonthDayYear
DateHourMinutesAM/PM Option
Date To:*

MonthDayYear
DateHourMinutesAM/PM Option
Half Day (only select if requesting one half day, to request multiple half days, please make a request for each half day)
Leave blank if requesting full days
Number of Hours Requested (Only list if requesting time less than a half day *a half day is 4.5 hours* Time requested must be 2 hours or greater)
Type of time off (PLFAW is Paid Leave For All Workers)

VacationPLFAWUnpaid Day
Notes
Approval

ApproveDeny
Admin Notes
Paid time off is utilized as vacation pay first if employee is eligible and has remaining balances, and then PLFAW. Please be aware of the time off you have remaining, as per your paycheck, when making a request.
Should be Empty: