PTO Request Form

PTO Request Form
Employee name:

First NameLast Name
Job title:
Today's date:

MonthDayYear
Date
PTO hours requested:
Beginning on:

MonthDayYear
Date
Ending on:

MonthDayYear
Date
Reason for request:

VacationPersonal leaveFuneral / bereavementJury dutyFamily reasonsMedical leaveOther (add description below):
Other reason:
I understand that this request is subject to approval by my supervisor.
Employee signature:

Clear
Thanks for your submission. Your supervisor will review this request and contact you within 48 hours.
Should be Empty: