; OVERTIME PAY REQUEST FORM
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OVERTIME PAY REQUEST FORM

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									                           OVERTIME PAY REQUEST FORM

  Date:

  Supervisor Name:
                                          (Please print)

  Overtime Pay is requested as follows:

  Employee Name:
                                          (Please print)

  Total Overtime Hours Worked at Regular Rate (< 40.00 hours per week) :

  Total Overtime Hours Worked at Overtime Rate (> 40.00 hours per week):

  Dates:

  Purpose of Overtime:



 NOTE: Please complete and submit to the Payroll Office for processing. Overtime sheets are
 due to Payroll with the regular weekly deadline.


  Department Name:                                                 Department #

  Employee Name:                                                   Employee #


    WEEK ENDING
     MM/DD/YY
                     SAT    S      M         T       W     TH     F        FOR ACCOUNTING ONLY




    WEEK ENDING
     MM/DD/YY
                     SAT    S      M         T       W     TH     F        FOR ACCOUNTING ONLY




Supervisor’s Signature: _________________________________________________


              SUBMIT ORIGINAL TO PAYROLL; KEEP A COPY FOR DEPARTMENT.




     Print Form

Updated: 08/27/09

								
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