PTO Cashout

Please submit this form by Monday, May 16 at 4 p.m.

Employee Name*

First Last

Employee Pin Number*

Program*

I elect to cash out the following PTO based on my available balance as of May 6, 2022. I understand that it is my responsibility to monitor the balance of my PTO. I will leave a balance for all upcoming PTO that has been approved by my supervisor. 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.

This PTO cash-out request will be paid out to me on my May 20, 2022 paycheck.

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 May 6, 2022
· Minimum cash out: 5 hours
· Maximum cash out: 25% of the balance as of May 6, 2022
· Cash out request must be submitted by 4 p.m. on- May 16, 2022

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PTO Cash Out Request Form