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Form – PTO Frederick
Matt Auman
2020-12-18T14:38:09-05:00
PTO Request Form - Frederick
PTO Request Form - Frederick
Employee Name
*
Requested Time Off
PTO Balance on Last Pay Stub
*
Hours of PTO Requested
*
PTO Begin Date
*
PTO End Date
*
By signing below, you acknowledge that if your paid time off balance does not cover the PTO requested, the excess time off will be unpaid time off.
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Today's Date
*
All time off must be approved so that we can ensure your shift is filled by another caregiver. Submission of this form does not guarantee approval. You must confirm approval with your Client Relationship Manager.
If you are human, leave this field blank.
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