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).