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Office of Human Resources This certifies that

Name of Employee

Overtime Request

is entitled to compensation for the following holiday time/overtime:

Holiday Time* Worked from





Mo Day Year

Holiday hours worked: Overtime hours worked:

Mo Day Year


Worked from Hour

to Hour


Reason holiday/overtime work was necessary:

Holiday/Overtime Work authorized by:

Immediate Supervisor Signature Method of Payment: Cash

Date Compensatory time

Department Head Signature


Employee Signature


* Holiday time is time worked on a legal state holiday. Employees will receive compensatory time off for all holiday time earned unless an employee elects to receive cash. ** Overtime, for a classified employee, is time worked in excess of 8 hours in one day or in excess of 40 hours in one week. For an unclassified employee, overtime is time worked in excess of 40 hours in a week. A non-exempt employee who works overtime must be compensated at a time and one-half rate in either cash or compensatory time, at the employee's option. Rev.11/29/2004


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