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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)
HH
:
MM
AM
PM
AM/PM
Expected/Incurred OT END Time
(Required)
HH
:
MM
AM
PM
AM/PM
Lunch Time Start
HH
:
MM
AM
PM
AM/PM
Lunch Time End
HH
:
MM
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
Brenda Maxey
Cathy Zimmerman
Chara Kemerling
Ciera Tiedtke
Desiree Loganbill
Dorinda Simmons
Faye Grounds
Lisa Vanwey
Heather Redd
Jim Suppes
Kathy Meyer
Kevin Hess
Lacey Mills
Misty Isley
Nathan Porter
Patty Clark
Stephanie Oden
Sonya Wolfe
Tyler Patterson
This person will approve or deny the OT Authorization Form
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