Peralta Community College District Overtime Request Form
This form shall be used to request prior authorization for overtime work. All requests for overtime
must be pre-approved by your immediate supervisor, as well as the area Vice Chancellor or College
President. All required signatures must appear on the form, prior to submitting to the college Business
Office, or District Department of Finance.
DATE OF REQUEST: ___________________
EMPLOYEE NAME: _________________________________
EMPLOYEE TITLE: __________________________________
DEPARTMENT: ____________________________________
NUMBER OF HOURS REQUESTED: __________
TOTAL COST OF OVERTIME (Hourly rate x 1.5): ____________________
REASON FOR OVERTIME/COMP TIME REQUEST:
BUDGET INFORMATION
APPROVALS
_________________________________ ________________________________
Employee Signature Date Vice Chancellor / President Date
Supervisor’s Signature Date College Business Director Date
Vice Chancellor, Finance Date
