Please use this form to request Paid Time Off. Once we receive the request, we will email you a copy of the request with either an approval or a justification as to why we cannot approve the request.

Once approved, the leave will be deducted from your PTO balance on your paycheck. This may put you in a small negative, that you will work to earn back prior to your scheduled leave. If you wish to cancel any approved PTO, you must do so at least 2 weeks in advance.

Name

First Name

Last Name

Email

Date Leave Requested Will Begin

MM

DD

YYYY

Number of Days Requested

Date You Will Return to Work

MM

DD

YYYY

Reason For Leave

Notes

Do you have enough PTO to cover this?

Yes

No

I am unsure

If you DO NOT have enough PTO, which would you like:

please understand that you may not be approved to carry a negative PTO balance

to request a negative balance that I will have to pay back

Unpaid Leave