Time Off Request Form

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All Prior Knowledge PTO requests (non-emergency, non-sick days) must:

- Be requested 14 days in advance (or cleared by your direct manager)
- Be approved by your direct manager
- Include a filled out a Time Off Request Form

Sick Days and Other Emergencies:

- Your direct manager must be notified as soon as is reasonably possible
- You must fill out a Time Off Request Form

For all questions about the PTO policy please reference the "Oozle Media's Employee Benefits Policy" or ask Amy Kunz. You can check your current balance of PTO at visit http://www.1sourcebusiness.com/

Employee's Name *

Requested Date(s) of Time Off *

The date(s) that you intend to take work off

Brief description of why you are taking time off *

Will you be taking PTO? *

Yes

Required

PTO Hours Taken *

Total number of PTO hours taken rounded to the nearest half hour (across all dates for this request)

Is this a floating holiday, if so which one?

Birthday - If so, add the date to the "Other" Line below

Bereavement - (if applicable)

Easter Monday April 2nd

Flag Day - June 14th

Halloween

Maternity/Paternity Leave

MLK Day

Non Traditional Religious Holidays

Pioneer Day - July 24th

Presidents Day

Purple Heart Day - August 7th

Scheduled Medical Recovery for Employee, Spouse or Child

St. Patricks Day

Teacher Work Day

The Day After Daylight Savings - Spring

Veterans Day

Other:

Clear selection

Hours of Un-Paid Time Off (if applicable)

Each employee has the option to take up to 5 day of un-paid time off each year.

Submit

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This form was created inside of Oozle Media.