Personal Time Off Form

Employee Name

Employee Phone Number

Zone Manager/ Supervisor Name

Dock Manager Name

Casino Location

Choose which action applies

Additional Comments

Number of Days Requested/ Called In

Select Days of Absence

1. Select a date of absense

2. Select a date of absense

3. Select a date of absense

4. Select a date of absense

5. Select a date of absense

6. Select a date of absense

7. Select a date of absense

Select Days of Absence

Date I will return to work:

I elect to use my Paid Time Off hours:

Use Paid Time Off

Yes

EMPLOYEE ACKNOWLEDGEMENT:

By signing below, I acknowledge that time away from work is subject to Management’s advance approval. I understand that it is my responsibility to keep track of my available Paid Time Off hours and that if for any reason I am paid for hours that were not available to me, the over payment will be deducted from my pay.

Your Signature

Thanks for submitting!

RENUoil of America, Inc.

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Personal Time Off Form