Employee Overtime Request Form

Use the form below to submit your overtime hours for review and approval. Please complete all applicable date entries, including your start and end times, total hours worked, and the reason for overtime for each day. Accurate and complete submissions help ensure timely processing and reimbursement.

This form supports up to five overtime dates per request. For each date, enter the shift start time in the “From” field and the shift end time in the “To” field, then provide the total hours eligible for pay and a brief reason for the overtime. Once all applicable dates are filled in, enter the total hours for the entire request before submitting.

If a reimbursement is associated with your overtime request, please complete the Reimbursement section at the bottom of the form, including the amount, date, and reason or location. All fields should be filled out as accurately as possible to avoid delays in processing.

Before You Submit

Please review the following guidelines to ensure your request is processed without delays:

• Double-check all start and end times for accuracy before submitting.
• Make sure the total hours field reflects the combined eligible hours across all dates entered.
• If you need to submit more than five overtime dates, please submit a separate request for the additional dates.
• Incomplete or inaccurate submissions may result in delayed approval or reimbursement.