BANKED OVERTIME ADJUSTMENT FORM - OPSEU Employee’s Name: ____________________________ Employee ID#: _________________________ Department: __________________________ Classification : _____________________ Level:__________________________________ Supervisor’s Name: ___________________________________ Date of Authorized Hours Eligible Date(s) Leave is Reason for Adjustment Leave Type Add to or Number of overtime/call in Overtime worked for Premium being Adjusted for Deduct from hours (m/d/yr) From To Compensation (m/d/yr) Balance ____________________________________________ ___________________________ Employee signature Date ____________________________________________ ___________________________ Supervisor signature Date *All overtime approved as time-off in lieu of payment must be approved by the employee’s supervisor. Lieu time untaken at year end will be paid out. This form is maintained and kept in the employee’s department. Submit a copy to Payroll for processing. Created January 21, 2016
BANKED OVERTIME ADJUSTMENT FORM - OPSEU Employee’s Name: ____________________________ Employee ID#: _________________________ Department: __________________________ Classification : _____________________ Level:__________________________________ Supervisor’s Name: ___________________________________ Date of overtime/call in (m/d/yr) Authorized Overtime worked Hours Eligible for Premium Compensation Date(s) Leave is being Adjusted for (m/d/yr) Reason for Adjustment Leave Type Add to or Deduct from Balance Number of hours From To ____________________________________________ ___________________________ Employee signature Date ____________________________________________ ___________________________ Supervisor signature Date *All overtime approved as time-off in lieu of payment must be approved by the employee’s supervisor. Lieu time untaken at year end will be paid out. This form is maintained and kept in the employee’s department. Submit a copy to Payroll for processing. Created January 21, 2016