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PTO BUY-BACK REQUEST FORM - Borgess Health

PTO BUY-BACK REQUEST FORM - Borgess Health 2026

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The PTO Cash Out Request Form allows eligible employees to sell back accrued Paid Time Off (PTO) up to four times a year, provided they made an election before January 1st. Employees must submit the form to Human Resources at least two pay periods in advance and must have been employed for a minimum of three years. The maximum payout is 100 hours, with a requirement to retain 40 hours in the bank.

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Click ‘Get Form’ to open the PTO BUY-BACK REQUEST FORM in our editor.
Begin by entering your name and employee ID in the designated fields. This information is crucial for identification purposes.
Next, fill in your department name and number. Ensure this matches your official records for accuracy.
Indicate the number of PTO hours you wish to sell back. Remember, this cannot exceed the amount you elected prior to January 1st of the current year.
Sign and date the form at the bottom. Your signature confirms that you understand the terms, including that you must have been employed for a minimum of three years to utilize this benefit.
Once completed, submit the form to Human Resources at least two pay periods before your desired payment date.

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