Preview University Employee Overtime Authorization Form

See other side

Georgia State University

Overtime Authorization Form

Today’s Date (MM/DD/YY): _______________

Employee Requesting Overtime: _____________________________________

(Print Name)

Employee Title: ___________________ Department: ___________________

Purpose of Overtime Work:

______________________________________________________________________________

Hours requested to be worked in excess of 40 per week: __________

Date and time of hours requested to be worked: _______________________

_______________________

 Request is authorized in full

 Request is not authorized

 Request is granted, subject to modification as follows:

_______________________________________________________________________

Supervisor Authorizing Overtime:

______________________________________

(Print Name and Title)

______________________________________ ____________

(Signature) (Date)

HTML Preview University Employee Overtime Authorization Form page number 1.