PTO Request Employee Name(Required) Date Request Made(Required) MM slash DD slash YYYY Type of Request(Required) Call Off PTO Funeral/Bereavement Jury Duty Extended Medical Leave Length of Request(Required) Full Day 1/2 day Date Range (Multiple Days) AM/PM(Required)Mark what half you need OFF AM PM Date Requested(Required) MM slash DD slash YYYY Explanation(Required) Start Date(Required) MM slash DD slash YYYY End Date(Required) MM slash DD slash YYYY Was this cleared through your supervisor(Required) Yes No Δ
