Time Off Request Form
Please enter this form when you need to request time off.
Employee Name
*
First Name
Last Name
Employee E-mail
*
Supervisor
Please Select
Jim Scranton
Chancey Foster
Bob Kramer
Larry Forst
Number of PTO Hours Requested
Start Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
Year
Start Date
*
-
Month
-
Day
Year
Date
All Day?
*
Please Select
Yes
No
Time From
AM
PM
AM/PM Option
End Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
Year
End Date
*
-
Month
-
Day
Year
Date
All Day?
*
Please Select
Yes
No
Time To
AM
PM
AM/PM Option
Reason For Time Off
*
Please Select
Vacation
Sick
Funeral
Maternity/Paternity
Other
Additional Comments
Submit
Should be Empty: