PTO DONATION FORM
Date: ____________________ Employee Name:
Employee #______________
_____
Department: __________________________________________
Requirements: You must have a balance of 40 hours in your PTO bank after making this donation.
The maximum amount of PTO you can donate is 40 hours.
Donation Agreement
I would like to donate _______________hours of PTO
to:
_____________________________________________
Name of Employee Receiving Donation
I certify that I meet the above-mentioned requirements in order to be able to make this donation.
I understand that this donation of benefit hours is unconditionally transferred and not revocable.
__________________________/_____________
Signature of Employee
Date
Please send or fax (x2731) to Lea Ann Corder in Human Resources.
Form No. 1533