PTO Request Form

Need a break, planning something special, or just need to get other things done outside of work?  We get it! If you need time off please let us know and be sure to follow all instructions below. We will not accept requests that do not adhere to the instructions, and we will do our very best to accommodate all valid request as we see fit.

PTO Request Instructions

When should I use this form?
This form must be submitted to request off from either a shift or a whole day/days and if you call off.  To receive pay for your accumulated PTO, you will need to view, on your most recent pay stub, the amount of hours that you have in your “bank”.

All PTO Requests Guidelines
If you are requesting off, you may use a minimum of one (1) hour and up to eight (8) hours.

  • You must request time off at least two (2) weeks in advance or earlier.
  • Four (4) weeks is ideal for proper coverage for our clients and approval for the time requested off. 

* We try our very best to provide time off when requested, we need you to do your part too. If request received did not provide 2 weeks notice, we reserve the right to deny request.

PTO Request to use accrued hours to cover Call Off
If you have called off due to an illness or other reasons, and you have accrued time in your “bank” you wish to use, you may only request the amount of hours you were scheduled.  However, if you were schedule with time that reflects 15, 30, or 45 minutes, you must round up or down to the next whole hour.  For this purpose, you must complete this form within 24 hours after the call off.

PTO Time Off Form

PTO Request Form

If you have questions about submitting your PTO Request please contact your Home Care Coordinator.
Please enter the date(s) you would like off. if you are requesting multiple sequential days off please enter the first date you would like to use your PTO. Please follow this format example: (August 25th start time 4pm)
If you are only requesting one day off this date should be the same as the PTO Start Date. If you are requesting multiple sequential days off please enter the last day you would like to use your PTO. please follow this format example: (August 25th end time 8pm)
Please include time frame of hours requested off i.e. 7am to 3pm
enter the client name, and scheduled shift time of the missed shift

By entering you email you are authorizing this request. Your Home Care Manager will email you within 48 hours to let you know the status of your request.

Sending