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Pump It Up of San Francisco Sick Leave Request
Use this form to request PTO hours per San Francisco/California Paid Sick Leave rules - Important: Do not use this form to notify us that you're not able to work. This form is just to request to be paid for the hours. You need to call and email the front desk managers separately to notify them if you're not able to keep your shift for any reason.
How to Use this form
Enter your name, dates that you were not able to work, and total hours that you were originally scheduled or are typically scheduled on those days. If your accrued PTO hours are less than this amount, you'll be given only up to the amount you've accrued.
Full Name *
Your answer
Date(s) unable to work *
Your answer
Total hours requested
Your answer
Allowed Uses
You can take paid sick leave for yourself or a family member*, for preventive care or diagnosis, care or treatment of an existing health condition, or for specified purposes if you are a victim of domestic violence, sexual assault or stalking.

Family members include the employee’s parent, child, spouse, registered domestic partner, grandparent, grandchild, and sibling.
* You can also take paid sick leave for the care of a pre-designated person.

Certification: Enter your name below, to certify that you are using the paid sick leave hours requested above for reasons allowed by the State of California or the City of San Francisco. *
Your answer
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