PSA Paid Time Off PTO Request Form

PSA Paid Time Off Request Form
PLEASE NOTE: IF YOU ARE A HOURLY EMPLOYEE, PLEASE FILL OUT THE FORM IN ANOTHER LINK: NON PAID TIME OFF REQUEST FOR HOURLY EMPLOYEE
Your Name*

First NameLast Name
Your Email
To get a copy of this request for your own
Date*

MonthDayYear
Supervisor*
Request Type*
PTO Start Date*

MonthDayYear
PTO End Date*

MonthDayYear
Total days requested*
Requesting Substitute Teacher?*

YesNo
Additional Notes
Please specify the reason if you choose other in the Request Type
Employee Signature*
Supervisor Signature

Clear
Should be Empty:

PSA Paid Time Off Request Form