Overtime Request/Settlement Form
Prior approval from Supervisor and the Human Resource Office is required.
Overtime requested for:
(Employee's Name)
Reason for Overtime:
Date(s) of Overtime:
Amount of hours requested
Employee Signature:
Payroll Office Use Only
Section I - Employee complete, print and submit to Supervisor:
Compensatory Time Off Overtime Compensation
To be paid by:
Date
Section II - Supervisor complete and submit to Human Resource Director prior to date of overtime:
Supervisor's Approval:
Human Resource Director's Approval:
Date
Date
Section III - Employee must complete settlement and submit to Supervisor after work is completed.
Supervisor must approve and return to Human Resource Office for processing.
Compensatory Time Earned Overtime Dollars Earned
Posted to Leave System Payment Date
HoursDate For Payroll Use Only
Employee Signature: Supervisor's Signature:
Supervisor's signature is a verification of overtime hours worked.
Print form and submit to Supervisor
