UUP OVERTIME-ELIGIBLE (Non-Exempt)
Employee Time Sheet
Employee Name: _______________________________________________
Dates of this payroll period: From ____________ Through _____________
Checking this box certifies that you worked your regularly assigned schedule,
AND have not worked in excess of 40 hours per week during the pay period.
(Proceed to signature line at the bottom).
Complete the following daily breakdown of time ONLY if you are claiming overtime for this pay period.
Date Day IN OUT IN OUT IN OUT
Hours
Worked
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Total number of hours worked over 40: __________ X 1.5 = _________ Total OT claimed
Date Day IN OUT IN OUT IN OUT
Hours
Worked
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Total number of hours worked over 40: __________ X 1.5 = _________ Total OT claimed
I certify that the information above is correct and an accurate reflection of my work during this pay period.
I also understand that any overtime listed above will be converted to comp time at the rate of
one and a half hours for every hour worked over 40 during any one week. I may choose to
receive overtime pay in lieu of comp time by informing my supervisor and payroll by separate memo.
Employee Signature/Date Supervisor Signature/Date
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signature
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signature
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