Paid Time Off Extension Request
Please fill out this form to request an extension for your paid time off.
Full Name
First Name
Last Name
Employee ID
Department
Please Select
Human Resources
Finance
Marketing
Sales
IT
Operations
Customer Service
Other
Original PTO Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Original PTO End Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Extension Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Extension End Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Extension
Supervisor's Approval
Submit
Should be Empty: