First Name:
Last Name:
Galaxy ID:
Employee Job Title: Department:
Supervisor/Dean: Campus: Extension:
Employee Type:
Describe work to be performed:
Start Date: End Date:
Employee Signature Date Supervisor/Dean Approval Date VP Approval Date
Date Reviewed by Executive Cabinet:
APPROVED DENIED
Superintendent/President Signature Date
(NOTE: Please forward completed request to your area Vice President for Executive Cabinet review.)
EXECUTIVE CABINET INFORMATION
Approval Request - For Hours Worked OVER Regular Schedule
Project and Justification Information:
Total # Extra Hours to
be worked:
(Attach approved document to monthly Timesheet when submitting to Payroll)
Date of Request:
PRINT
Full-Time
SJC
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signature
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