Time Off Request Form Name* First Last Email* My Supervisor is:*CindyCristineIanTerrelYour supervisor will be notified via email after submission of this form. They will notify you if the PTO has been approved OR denied.Reason for Time Off* PTO Parental Leave Bereavement Leave Jury Duty Voting Please see Employee Handbook for all types of leave.Number of Requests*12345#1 – Requested Leave Start Date* MM slash DD slash YYYY #1 – Requested Leave End Date* MM slash DD slash YYYY #1 – Requested PTO Hours*#1 – Comments#1 – Will you have accrued sufficient PTO hours by the requested leave date?* Yes No As a reminder, all full-time staff members accrue 13.3 PTO hours per month. Staff are permitted to “advance” use of PTO subject to manager approval. Please check your PTO balance if you are unsure.#1 – How many PTO hours are you requesting to advance?*#1 – Agreement* I have requested to take PTO for a number of hours which is more than the number of PTO hours for which I will have earned to the date. I request that CNE advance PTO pay to me for the amount of PTO hours I’ve listed in the previous question.#1 – Authorization* In the event that my employment is terminated, or I resign prior to earning enough PTO hours to cover this advance, I agree to: (A) Repay any remaining unearned balance at the time I cease to be employed by CNE; and to (B) Allow CNE to deduct any amount which I owe from my last paycheck and/or any future commission checks which may be due to me after the termination of my employment.#2 – Requested Leave Start Date* MM slash DD slash YYYY #2 – Requested Leave End Date* MM slash DD slash YYYY #2 – Requested PTO Hours*#2 – Comments#2 – Will you have accrued sufficient PTO hours by the requested leave date?* Yes No As a reminder, all full-time staff members accrue 13.3 PTO hours per month. Staff are permitted to “advance” use of PTO subject to manager approval. Please check your PTO balance if you are unsure.#2 – How many PTO hours are you requesting to advance?*#2 – Agreement* I have requested to take PTO for a number of hours which is more than the number of PTO hours for which I will have earned to the date. I request that CNE advance PTO pay to me for the amount of PTO hours I’ve listed in the previous question.#2 – Authorization* In the event that my employment is terminated, or I resign prior to earning enough PTO hours to cover this advance, I agree to: (A) Repay any remaining unearned balance at the time I cease to be employed by CNE; and to (B) Allow CNE to deduct any amount which I owe from my last paycheck and/or any future commission checks which may be due to me after the termination of my employment.#3 – Requested Leave Start Date* MM slash DD slash YYYY #3 – Requested Leave End Date* MM slash DD slash YYYY #3 – Requested PTO Hours*#3 – Comments#3 – Will you have accrued sufficient PTO hours by the requested leave date?* Yes No As a reminder, all full-time staff members accrue 13.3 PTO hours per month. Staff are permitted to “advance” use of PTO subject to manager approval. Please check your PTO balance if you are unsure.#3 – How many PTO hours are you requesting to advance?*#3 – Agreement* I have requested to take PTO for a number of hours which is more than the number of PTO hours for which I will have earned to the date. I request that CNE advance PTO pay to me for the amount of PTO hours I’ve listed in the previous question.#3 – Authorization* In the event that my employment is terminated, or I resign prior to earning enough PTO hours to cover this advance, I agree to: (A) Repay any remaining unearned balance at the time I cease to be employed by CNE; and to (B) Allow CNE to deduct any amount which I owe from my last paycheck and/or any future commission checks which may be due to me after the termination of my employment.#4 – Requested Leave Start Date* MM slash DD slash YYYY #4 – Requested Leave End Date* MM slash DD slash YYYY #4 – Requested PTO Hours*#4 – Comments#4 – Will you have accrued sufficient PTO hours by the requested leave date?* Yes No As a reminder, all full-time staff members accrue 13.3 PTO hours per month. Staff are permitted to “advance” use of PTO subject to manager approval. Please check your PTO balance if you are unsure.#4 – How many PTO hours are you requesting to advance?*#4 – Agreement* I have requested to take PTO for a number of hours which is more than the number of PTO hours for which I will have earned to the date. I request that CNE advance PTO pay to me for the amount of PTO hours I’ve listed in the previous question.#4 – Authorization* In the event that my employment is terminated, or I resign prior to earning enough PTO hours to cover this advance, I agree to: (A) Repay any remaining unearned balance at the time I cease to be employed by CNE; and to (B) Allow CNE to deduct any amount which I owe from my last paycheck and/or any future commission checks which may be due to me after the termination of my employment.#5 – Requested Leave Start Date* MM slash DD slash YYYY #5 – Requested Leave End Date* MM slash DD slash YYYY #5 – Requested PTO Hours*#5 – Comments#5 – Will you have accrued sufficient PTO hours by the requested leave date?* Yes No As a reminder, all full-time staff members accrue 13.3 PTO hours per month. Staff are permitted to “advance” use of PTO subject to manager approval. Please check your PTO balance if you are unsure.#5 – How many PTO hours are you requesting to advance?*#5 – Agreement* I have requested to take PTO for a number of hours which is more than the number of PTO hours for which I will have earned to the date. I request that CNE advance PTO pay to me for the amount of PTO hours I’ve listed in the previous question.#5 – Authorization* In the event that my employment is terminated, or I resign prior to earning enough PTO hours to cover this advance, I agree to: (A) Repay any remaining unearned balance at the time I cease to be employed by CNE; and to (B) Allow CNE to deduct any amount which I owe from my last paycheck and/or any future commission checks which may be due to me after the termination of my employment.
