Employee Time Off Request Form (Service Providers)

Employee Time Off Request

Service Providers
*FOR SERVICE PROVIDERS ONLY*

Please submit the dates you're requesting to take off of work 30 days in advance. PTO requests must be submitted a minimum of 2 weeks in advance to ensure we have time to add to the corresponding pay period.

PTO requests cannot exceed the hours scheduled! As a reminder, PTO hours will be paid out at $15 per hour. For example, If you are scheduled to work an 8-hour shift, you will only be approved for 8 hrs.
Name

First NameLast Name
Today's Date

MonthDayYear
Date
Email
example@example.com
Configurable list
Date Range Requested off (Consecutive days)
Time Period Requesting Off (i.e., 9:30-11 am)
PTO Requested?
If yes, number of hours requested
Employee Signature
Should be Empty: