PTO/PSL REQUEST Please enable JavaScript in your browser to complete this form.Enter Your NameEmployee Number *Job Title *Choose Your Department *Table GamesPokerFood & BeverageCageSecuritySurveillanceAccountingFacilitiesCorporateChoose Leave Type (Choose 1)PTOPSLIs this for a past date or advance request?Leave already TakenFuture DatePSL Hours RequestedDate(s) RequestedMy PSL Balance If a partial day is requested, please list the times: From:To: BY SIGNING BELOW • I confirm that my request for PSL is for an AUTHORIZED PURPOSE for me or a family member, as defined in the Paid Sick Leave Policy and Washington State Initiative Measure No. 1433; and • I understand it is my responsibility to contact the Washington State Department of Labor and Industries if I have questions about what is considered an Authorized Use of PSL; and • I understand that a “PSL Verification” form may be required for absences exceeding THREE (3) consecutive scheduled work days (see the Paid Sick Leave Policy for additional information). This form must be completed regardless of full-time or part-time employment. If you are an employee with a Paid Time Off (PTO) Balance, you may use PTO to replace your normally scheduled work hours, whether the time off was for personal needs or you left work due to the needs of the Company. However, PTO hours will not be applied if it puts you into overtime. (Additional separate forms are available in Human Resources for Paid Sick Leave, Jury Duty, Military Leave, Family & Medical Leave, and Unpaid Leaves of Absence.)My PTO BalanceSee the Time Off Request Procedure for Detailed Instructions on Completing this Form Choose OneI want to request the following day(s) off and use my PTO hours for the time lossI am leaving my scheduled shift early and want to use my PTO for the time loss(“Bring me up to…”) If I have a shortage from my weekly scheduled work hours, please use my PTO for the time lossI do not have a PTO benefitI do not wish to use my benefitMy PTO bank is depleted, and I am requesting these day(s) off without pay this Section Date(s) Scheduled Work HoursDatesScheduled Work HoursDates Week 1Choose OneYesNoWeek 1 Maximum Hours to useWeek 2Choose OneYesNoWeek 2 Maximum Hours to use**If you take a different day off during the pay period due to a change in plans, NO PTO hours will be applied for the replacement day, unless you complete either a new “Time Off Request” requestDatesCommentsSignature * Clear Signature Print Name *Submit
