Paid Time off Request (PTO Form)

Paid Time off Request (PTO Form)
Bridgeway Paid Time Off (PTO) Request Guidelines

Use this form to request Paid Time Off (PTO) or to cash out accrued PTO hours. When requesting time off, please obtain prior approval from your client to support continuity of care and appropriate scheduling. Only fully completed forms will be processed.

To ensure payment on the upcoming payday, submit your request by Monday at 4:00 PM (Week 2) preceding the pay date.

Reminder: Your current PTO balance is available on your pay stub or through the ADP Portal.
Caregiver Name*

First NameLast Name
Caregiver Email*
example@example.com
Client Name*

First NameLast Name
Date of Request*

MonthDayYear
Date
Caregiver IllnessCaregiver UnavailableClient HospitalizedClient UnavailablePlanned Time OffOther
Number of Hours Requested*
PTO HRS (View Available Balance on your Checkstub or ADP)
Yes
Signature
Should be Empty: