OVERTIME REQUEST SETTLEMENT FORM

SECTION I – The employee should complete this section and submit the form to the supervisor.

EMPLOYEE NAME	EMPLOYEE ID	DATE FORM SUBMITTED
DATE(S) OF OVERTIME
EXPLANATION OF OVERTIME WORK
# OF HOURS REQUESTED	TO BE PAID BY:	Compensatory Time Off	Overtime Compensation
EMPLOYEE SIGNATURE	DATE

SECTION II – The supervisor should complete this section and submit it to HR prior to the date of overtime.

SUPERVISOR APPROVAL	DATE

HR APPROVAL	DATE

SECTION III – The employee must complete the settlement and submit it to the supervisor after the work is completed.

The supervisor must approve the settlement and return it to HR for processing.

DATE	HOURS	For Payroll Use Only

EMPLOYEE SIGNATURE	DATE

SUPERVISOR SIGNATURE	DATE

The supervisor’s signature is a verification of the overtime hours worked.

–––––––––– PAYROLL USE ONLY ––––––––––
COMPENSATORY TIME EARNED	OVERTIME DOLLARS EARNED
POSTED TO LEAVE SYSTEM	PAYMENT DATE
PROCESSED BY	DATE PROCESSED

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