PTO / TIME-OFF REQUEST FORM

Employee information

• Employee name: [EMPLOYEE NAME]
• Department: [DEPARTMENT]
• Manager: [MANAGER NAME]
• Date submitted: [DATE]

Request details

• Leave type: [ ] Vacation/PTO [ ] Sick leave [ ] Personal day [ ] Unpaid leave [ ] Other: __________
• First day out: [DATE]
• Last day out: [DATE]
• Return date: [DATE]
• Total hours requested: [HOURS]
• Half day? [ ] No [ ] AM only [ ] PM only (date: __________)
• Reason (optional): _______________________________________________

Coverage plan

• Coverage contact: [NAME] — briefed on urgent items: [ ] Yes [ ] N/A
• Open items / handoff notes: _______________________________________________

Balances (HR to complete)

• Available balance: __________ hours | Balance after request: __________ hours

Approvals

Employee signature: ___________________________ Date: ______________

Manager: [ ] Approved [ ] Denied — Signature: ___________________________ Date: ______________

HR received: ___________________________ Date: ______________ Payroll updated: [ ] Yes

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General template only — not legal advice. Have employment counsel review before use, especially for state-specific requirements. Downloaded from AskHrAI (https://askhrai.com/forms/pto-request-form).