R PTO DONATION REQUEST FORM - Amazon S3

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PTO DONATION REQUEST FORM

Paid Time Off (PTO) is a benefit Viafield offers to team members to help ensure a healthy work/life balance. There are times when team members may require more time away from work due to unforeseen circumstances. Our Senior Leadership Team supports team members helping team members during these situations through PTO donations. The SLT member of your division must approve the PTO Donation request. Although a low balance may drive PTO donations, the Leadership team will also consider other donation opportunities on a situational basis. Please complete the bottom portion of this form and submit to the Human Resources department. I would like to help a team member in need. Per this signed authorization, please transfer _________ hour(s) (increments of 1 hour only / cap 40 hours / one donation opportunity per calendar year unless authorized) PTO from my earned balance to the PTO balance of ________________________________.

(Team Member Name)

By signing below I understand these hour(s) will no longer be owed to me at any point in the future and that donating PTO is confidential, unless I choose to disclose this information. I also understand that this is my only donation for the calendar year.

Your name: ______________________________________________ Date: _________________________

(Please Print)

Your signature: __________________________________________________________________________

Senior Team Leader signature: ______________________________________________________________

Payroll use only: HR authorization: _________________________________________ Date: __________________________

07/2018

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