PTO (Paid Time Off) Request/Approval
Date Prepared: _____ /_____ /_____
Name: ___________________________________ Employee number: __________ Department Number: ______________
Amount of PTO time requested: __________ Days / Hours (Circle One) AM / PM (Circle One)
Date(s) for which PTO is requested
From: __________ __________ __________ Through: __________ __________ __________
(1st Day Off) (Month) (Day) (Year) (Last Day Off) (Month) (Day) (Year)
Comments: ___________________________________________________________________________________________________
Approved By: ______________________________________________________________________ Date: _____ /_____ /_____
(Authorizing Supervisor's Signature)
PTO (Paid Time Off) Request/Approval
Date Prepared: _____ /_____ /_____
Name: ___________________________________ Employee number: __________ Department Number: ______________
Amount of PTO time requested: __________ Days / Hours (Circle One) AM / PM (Circle One)
Date(s) for which PTO is requested
From: __________ __________ __________ Through: __________ __________ __________
(1st Day Off) (Month) (Day) (Year) (Last Day Off) (Month) (Day) (Year)
Comments: ___________________________________________________________________________________________________
Approved By: ______________________________________________________________________ Date: _____ /_____ /_____
(Authorizing Supervisor's Signature)