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PTO / TO/ Vacation - Request Form Print Form Employee Name Department Supervisor Start Date End Date Total Days Reason Code O PV Paid Vacation Day Where employee has worked a holiday and is owed a vacation day. V- Vacation Day Unpaid Taking a holiday vacation day that is not part of the vacation package at SESC F - Floater Day These are days given to you to use at your choice of time. PL - Personal Leave Paid pto Taking time off for personal reasons. M - Maternity Family Care Leave Unpaid Taking time off after giving birth. MU - Pregnancy Disability Leave Unpaid Taking time off after giving birth. MED Medical Leave Unpaid non-occupational illness or disability other than pregnancy childbirth or related medical condition* JD Jury Duty Paid one day of jury duty is allowed to be paid by SESC JDU Jury Duty Unpaid additional days of jury duty taken* MIL Military Leave Unpaid An unpaid leave of absence for required military service. WC Workers Compensation A leave of absence because of work-related illness or injury. BL Bereavement Leave paid A paid leave of absence to attend the funeral of an immediate family member. FLIM Funeral Leave paid When a death occurs in an employee s immediate family. NFMFL Non Family Member Funeral Leave paid one day toattend the funeral of a close non-family member. ATF Additional Time Off For Funeral unpaid in the instance of the death of an immediate family member. O- Other - Please explain note you do not need to submit this form to take a SESC Paid holiday as described in the handbook Employee Signature by signing this document employee agrees to the accuracy of above reasons for leave and verifies all information on this document is true and understands that any false statements or inputs above can result in termination Date Additional comments by employee Manager Signature approve not approved Date manager. V- Vacation Day Unpaid Taking a holiday vacation day that is not part of the vacation package at SESC F - Floater Day These are days given to you to use at your choice of time. PL - Personal Leave Paid pto Taking time off for personal reasons. M - Maternity Family Care Leave Unpaid Taking time off after giving birth. PL - Personal Leave Paid pto Taking time off for personal reasons. M - Maternity Family Care Leave Unpaid Taking time off after giving birth. MU - Pregnancy Disability Leave Unpaid Taking time off after giving birth. MED Medical Leave Unpaid non-occupational illness or disability other than pregnancy childbirth or related medical condition* JD Jury Duty Paid one day of jury duty is allowed to be paid by SESC JDU Jury Duty Unpaid additional days of jury duty taken* MIL Military Leave Unpaid An unpaid leave of absence for required military service. MU - Pregnancy Disability Leave Unpaid Taking time off after giving birth. MED Medical Leave Unpaid non-occupational illness or disability other than pregnancy childbirth or related medical condition* JD Jury Duty Paid one day of jury duty is allowed to be paid by SESC JDU Jury Duty Unpaid additional days of jury duty taken* MIL Military Leave Unpaid An unpaid leave of absence for required military service. WC Workers Compensation A leave of absence because of work-related illness or injury. BL Bereavement Leave paid A paid leave of absence to attend the funeral of an immediate family member.

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