Employee Time Off Request Form (Wellness Advisors and Managers)

Employee Paid Time Off Request

Wellness Advisor and Managers
*Wellness Advisor and Managers 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! 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
Time Period Requesting Off (i.e., 9:30-11 am)
PTO Requested?
If Yes, number of hours requested
Employee Signature
Should be Empty:

Employee Paid Time Off Request