Paid time off request form

As a reminder, the follow is our policy, in conjunction with Arizona State law.

Effective July 1, 2017, employees began to accrue paid sick leave or Paid Time Off (PTO) equivalent. For every 30 hours worked, one hour of PTO is accrued, not exceeding 40 hours. PTO may be applied to scheduled hours only. PTO may be used 90 days after the employee’s hire date and does not expire at the end of the year; employees may not use more than 40 hours of sick time in a year. Worth Takeaway does not pay out PTO at the end of employment.

The employee may use PTO for the following occurrences:

Mental or physical illness of the employee;

To care for a family member’s mental or physical illness;

A public-health emergency;

and domestic violence, sexual violence, or stalking.

If an employee calls out and does not have accrued PTO, they may be asked to provide a doctor’s note.

Employees are allowed to use accrued PTO as a personal day or vacation time if it is requested in advance.

Three or more consecutive days of calling out sick requires a doctors note before returning to work.

Please fill out the following form if you wish to apply your accrued PTO to time recently taken off due to illness.

Name

First Name

Last Name

Enter in dates in which you would like to apply your PTO to

Dates listed should be within the current pay period.

Number of hours you wish to apply towards your PTO

If the number you've requested exceeds your total hours accrued, the total number of hours accrued will be applied to your paycheck

Reason for requesting time off

Confirm Below

I want to use my accrued PTO to cover for time I plan to take off for vacation or personal reasons.

PTO Request Form

Paid time off request form