GOVERNMENT / MILITARY

OVERTIME REQUEST FORM

ORGANIZATION NAME
DEPARTMENT
CONTACT INFORMATION
SUBMIT COMPLETED FORM TO:
EMPLOYEE NAME	PAY PLAN	PAY GRADE	OVERTIME START DATE	OVERTIME END DATE	OVERTIME HOURS *	ELECTED **	REQ'D ***
JUSTIFICATION Provide a description of the work and the reason for overtime.
REQUESTED BY
NAME	TITLE	DEPARTMENT	DATE
APPROVAL
NAME	TITLE	SIGNATURE	DATE
* Exclude meal periods	APPROVED
** Employee must initial
*** Authorized Officer must initial	DISAPPROVED

INSTRUCTIONS

The completed form is returned to the requesting officer, who will forward the approved form to the timekeeper for retention with timekeeping records. The form is retained for [three years] following the fiscal year in which the overtime time was performed.

Several employees may be listed on one form when all the conditions are identical. The officials who may approve the overtime are designated [in the organization’s policies or manual].

Wage employees must receive pay for all overtime.

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