PTO Cash Out Request Form "*" indicates required fields Please submit this form by Monday, November 13, at 4 p.m.Employee Name* First Last Employee Pin Number* Program*Select OneAbe's PlaceArborBandelBel AirButlerBusiness OfficeButtersEastwoodFergusonForest KnollFoundationFSSGlendaleHarvestviewHuman ResourcesLake MeadowMaintenanceManagementMiddlebrookNursingOak LaneOronocoPinewoodRidgeviewStone BridgeValkyrieWeatherstoneWood LaneI elect to cash out the following PTO based on my available balance as of November 3, 2023. I understand that it is my responsibility to monitor the balance of my PTO. I will leave a balance for all upcoming PTO that my supervisor has approved. If my PTO balance is not sufficient to cover the PTO previously approved, my PTO request may be denied.I would like to cash my PTO out based on:* Hours Percent Number of Hours*Percent of Hours*Consent* I agree to the payout terms outlined below, and I understand that if I am not eligible due to any of the outlined criteria, my request will not be processed.Qualifications for PTO cash out: · Full- or Part-Time employees who have worked at least 90 days · Must have at least 20 hours of available PTO as of November 3, 2023 · Minimum cash out: 5 hours · Maximum cash out: 25% of the balance as of November 3, 2023 · Cash out request must be submitted by 4 p.m. on November 13, 2023 Requests will be paid out on the November 17, 2023 paycheckCAPTCHA
