Employee PTO Request and Approval Form

Form

Employee Name: ___ Property / Division: ___

Position / Department: ___ Supervisor: _______

Employment Type: Salary / Hourly PTO Type: Vacation / Sick / Personal

First Day Off: ___ Last Day Off: ___

Total PTO Days: ___ Hours if Hourly: ___

Date Submitted: ___ Current PTO Balance: ___

Employee certifies requested PTO is accrued and understands late approval or late paperwork may move pay to the next regular paycheck.

Employee Signature: ______ Date: ________

PTO Balance Verified: Yes / No Staffing Impact Reviewed: Yes / No

Request Status: Approved / Denied / Alternate Dates Approved

Alternate Dates / Notes: ________

Supervisor Signature: ____ Date: ________

Salary cutoff: 12:00 PM on the 3rd business day before payday. Hourly cutoff: on the signed Wednesday before-payday time sheet. Business day means Monday through Friday excluding federal holidays.

Date Received: ______ Pay Group: Salary 15th / Salary Month-End / Hourly Friday

Payroll Check: ______ Cutoff Met: Yes / No Time Sheet Confirmed: Yes / No / N/A

Final Disposition: Current Check / Next Check / Manual Correction

HR / Payroll Notes: _____________

HR / Payroll Signature: ____ Date: ______