PTO Request Form. Name * First Name Last Name Fill Out Section One for Days or Fill Out Section Two for Hours * I am requesting one or more days off and I am filling out section one. I am requesting hours off and I am filling out section two. SECTION 1 Fill out this section to request DAYS. If you are requesting hours, skip this section. Number of Days Requested If you are not taking one or more full days off, skip this section and go to "Number of Hours." Starting On: This is the first day of your time off. MM DD YYYY Returning to Work On: What day will you be back at work? MM DD YYYY SECTION 2 Fill out the form below to request HOURS. If you are requesting days, use Section 1 and skip this section. Number of Hours Requested Date What day will you take these hours? MM DD YYYY From Hour Minute Second AM PM To Hour Minute Second AM PM Type of Request * Professional Development Medical/Wellness Leave Personal Leave Jury Duty Bereavement I understand that time away from work is subject to management approval and company policies. * Yes No Thank you!
