A simple PTO request form gives you a written record of every time-off request and decision, so balances stay accurate and approvals are fair.
Download free (Word .docx)Free · No sign-up · Opens in Microsoft Word and Google Docs · Last reviewed October 2026
Important: please read
This template is a free starting point, not legal advice. MadyHR.ai is not a law firm and cannot give legal advice. Employment law is different in every state, and some cities have their own rules. Laws also change. Before you use this template, check it against the laws where your employees work, and speak to an employment attorney or your state labor department if you are unsure. You use this template at your own risk, and MadyHR.ai accepts no responsibility for how it is used. Links to official government websites are given for information only; MadyHR.ai is not affiliated with or endorsed by any government agency.
When to use this template
Planned vacation or personal days
Tracking requests without HR software
Recording a manager's approval or denial
Tips before you use it
Respond to requests promptly and consistently, in the order they arrive.
Leave protected by law (for example FMLA, state sick leave, military or jury duty) follows its own rules — do not deny it under your PTO process.
Keep approved forms with payroll records.
Template preview
Replace everything in [brackets] and delete the notes for employers before you use it. The Word download contains the full template.
[Company Name]
PTO Request Form
Employee section
Employee name: [Employee Name]
Department: [Department]
Date of request: [Date]
First day off
Last day off
Date returning to work
Total hours / days requested
Type of leave (PTO / vacation / personal / unpaid / other)
Notes (optional)
Employee
Signature
Date
Manager section
Approved
Approved with changes
Denied
Reason if changed or denied
PTO balance before request
PTO balance after request
Manager
Signature
Date
Note for employer (delete before use): If the absence may be for a medical reason, military service, jury duty or another legally protected reason, do not deny it on this form — refer it to [HR Contact Name].
Yes, for ordinary vacation, if your policy allows it and you apply it consistently. Leave protected by law, such as FMLA or state paid sick leave, cannot be denied for business convenience.
How far in advance should employees request PTO?
Most policies ask for one to four weeks' notice for planned time off. Set the rule in your PTO policy and apply it to everyone.
Official sources
Each source below is an official U.S. government website. Check them for the latest rules.
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