PTO Request Form Submit this form to request time off "(This Field Is Required)" indicates required fields Requests for time off (paid or unpaid) must be submitted and approved two weeks before the first date of the event. This form is to be used for more than four hours off. Name(This Field Is Required) Common Name Your NSA Email Address(This Field Is Required) PTO Approver(This Field Is Required)Select the person who approves your PTO from the list below:Please SelectBrandonTateCodyStephJimJosieEmilyRequest to Work From Home If Applicable Yes No Is this request for less than 8 hours?(This Field Is Required) Yes No Please describe time exception needed:(This Field Is Required)Date PTO Starts(This Field Is Required) MM slash DD slash YYYY Is this request for more than one day?(This Field Is Required)If yes, another box will appear to enter the end date Yes No Check if you wish to take as unpaid time off Yes Date PTO Ends MM slash DD slash YYYY ReasonNot required, but always interesting if you'd like to share. Please do not share any HIPAA-related information unless you understand that your form and contents may be seen by multiple NSA employees.Is this request for more than 10 days in a 30 day period?(This Field Is Required)If yes, your request will need a second sign off, the email will be sent automatically Yes No Consent(This Field Is Required)I understand that a request for time off is not guaranteed and is subject to the discretion of the Company. If requesting more than 14 days off within a 30-day period, this request will require an additional approval. This will occur automatically. I agree to ensure and coordinate appropriate coverage in my absence. I agree and understandCheck if the following applies: I am special! Δ
