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Employee Time Off Request Form

Note: PTO must be taken in full days, PWL may be taken hourly.

Department
I am requesting (choose one):
PTO (Paid Time Off)
PWL (Personal Wellness Leave)
For PWL, Select from below:
Start Time (for PWL only)
Time
HoursMinutes
End Time (for PWL only)
Time
HoursMinutes

Note: If only requesting a single day of PTO, please enter the same date in both the Start Date and End Date fields.

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