Employee PTO Acknowledgment

EMPLOYEE PTO ACKNOWLEDGMENT

Employer Name:    Employee Name:

Personal Information

Position Information

Start Date:    Salary/Hourly Rate:

Employment History

Education

References

PTO POLICY ACKNOWLEDGMENT

I acknowledge that I have received, reviewed and understand the Employer's Paid Time Off (PTO) policy. I understand the policy sets forth the rates of accrual, procedures for requesting PTO, approval requirements, documentation requirements for absences, and disciplinary measures for abuse or falsification of PTO requests. I agree to comply with the policy as a condition of my employment.

Accrual and Use: PTO accrues according to the schedule in the policy and is subject to caps and maximum accrual limits. Accruals are prorated for partial pay periods. PTO must be requested in advance when practicable and approved by the employee's manager. Unused PTO is subject to carryover or payout rules described in the policy and subject to state law where applicable.

Termination and Payout: Payout of accrued but unused PTO upon separation is governed by the policy and applicable state law. Payment may be subject to offsets for unreturned property or other lawful deductions.

Interaction with Leave Laws: Employer's PTO policy is administered consistent with applicable federal, state and local leave laws. Where statutory leave (such as family or medical leave) applies, those laws will supersede or supplement PTO use in accordance with the policy.

Policy Changes: Employer reserves the right to modify, revoke, suspend, terminate, or change any or all of the provisions of the PTO policy at any time, with or without notice, to the extent permitted by law.

I confirm that I received a copy of the PTO policy and that I understand my responsibilities for requesting, documenting and using PTO. I further acknowledge that failure to follow policy procedures may result in disciplinary action, up to and including termination.

I acknowledge receipt of the PTO policy and agree to comply with its terms.

LEGAL DISCLOSURES

At-Will Employment: I understand that unless otherwise provided in a separate written agreement signed by an authorized representative of the Employer, my employment is at-will and may be terminated by either party at any time, with or without cause or notice.

Equal Employment Opportunity: Employer provides equal employment opportunity to all employees and applicants without regard to protected characteristics as defined by applicable law. Employment decisions are made on the basis of qualifications, performance and business needs.

APPLICANT / EMPLOYEE CERTIFICATIONS AND AUTHORIZATIONS

I certify that the personal, employment history, education and reference information I have provided on this form is true and complete to the best of my knowledge. I understand that falsification, omission or misrepresentation of information may result in disciplinary action or termination of employment.

Authorization to Verify: By signing below I authorize the Employer and its agents to contact my prior employers, educational institutions and listed references to verify the information provided, and to conduct background checks as permitted by law. I release those contacted and the Employer from liability for providing or obtaining such information in good faith.

I authorize verification of my employment, education, references and background as described above.

ADDITIONAL NOTICES

Documentation: The Employer may require documentation supporting PTO requests for reasons such as extended illness or bereavement. Failure to provide required documentation may result in denial of PTO or disciplinary action.

Privacy: Information collected on this form will be used for employment records and payroll administration and will be maintained in accordance with Employer policies and applicable law.

EMPLOYEE CERTIFICATION

I acknowledge that I have read and understand the statements above. I understand that signing this acknowledgment does not alter the at-will nature of my employment unless a separate written agreement signed by an authorized representative of the Employer states otherwise.

I certify that all information provided on this form is true and complete and that I accept and understand the PTO policy terms as stated above.

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