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Employee Portal
Overtime Authorization Form
Employee Name
(Required)
First
Last
Employee Email
(Required)
Employee ID Number
(Required)
Employee Regular Work Location
(Required)
Is the Overtime Planned or Unplanned (select one)?
(Required)
Planned
Unplanned
Date Overtime is Expected or Incurred
(Required)
MM slash DD slash YYYY
Expected/Incurred OT START Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Expected/Incurred OT END Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Lunch Time Start
Hours
:
Minutes
AM
PM
AM/PM
Lunch Time End
Hours
:
Minutes
AM
PM
AM/PM
Check this Box if NO Lunch was Taken
No Lunch Taken
Hours of Overtime Expected/Incurred
(Required)
Location of Overtime
(Required)
Reason for Overtime (Please Mark One)
(Required)
Client Service Related: Shopping, Banking, Appointments, Recreation and Social Leisure, Etc.
Meetings/Training
Documentation
On-Call/Fill-In
Miscellaneous
Purpose/Why the Overtime is Needed/Required
(Required)
Who is your Team Leader or Supervisor?
(Required)
SELECT YOUR SUPERVISOR
Aly Spradling
Angela Penner
Andrea Delgado
Candice Miranda
Chara Kemerling
Ciera Tiedtke
Dorinda Simmons
Faye Grounds
Lisa Vanwey
Heather Redd
Jim Suppes
Kathy Meyer
Kevin Hess
Kylie DeGarmo
Lacey Mills
Lance Rutan
Misty Isley
Nathan Porter
Nicky Nelson
Patty Clark
Stephanie Oden
Sonya Wolfe
Tyler Patterson
This person will approve or deny the OT Authorization Form
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