RECEIVEDHR
Paid Time Off (PTO) Request Form
Form HR-117 · Rev. 11/2026Employee Information
Employee name
Employee ID
Department
Supervisor / Manager
Date of request
Type of Leave
Vacation
Sick
Personal
Bereavement
Jury duty
✓Other:
Dates Requested
First day off
Last day off
Return to work
Workdays
Total hours requested
Coverage while out
Reason for Request / Comments
Signatures
Employee signature
Date
For manager / HR use only
Approved
Approved, but I want screenshots
Denied
Manager signature ____________________ Date ________
Submit at least 2 weeks in advanceMade with PTO Boss