BP-A0369 U.S. DEPARTMENT OF JUSTICE
JUN 10 OVERTIME AUTHORIZATION
FEDERAL BUREAU OF PRISONS
MCC New York
(Institution Location)
5 August 2019
To
(Name of Employee)
You are authorized to work overtime as follows:
Day of Week: Monday Date: 5 August 2019
Starting: 1500 Approximate period: 90 minutes
Purpose: project planning and administrative duties
Reasons work cannot be accomplished during regular tours of duty:
Shortage of administrative staff
Warden or Authorized Supervisor
In accordance with above authorization I certify I worked the following overtime:
Day of Week: Monday Date: AUX,USI 2019
Starting: 1500 Approximate period: 90 minutes
and request: Overtime Pay XXXXXXXXXX
Compensatory Time
(Signature of Employee)
Time verified (supervisor's initial)
(To be used where not authorized Approved:
in advance by Warden)
Warden
Instructions:
(1) Where several employees authorized, use reverse side and insert in space for "name of employee' the words
'per names and periods on reverse side.'
(2) "Authorized Supervisor' in accordance with written delegation of authority at institutional level per regulations.
(3) To be prepared in Original only, processed in accordance with Institutional regulations and filed in payroll (older.
PDF Prescribed by P3000
EFTA00036122
BP-E369 (Continued)
*When employee signs he/she should indicate "P" for Overtime Pay or "C" for Com pensatory time
Name of Employee Dale Time Time P' Signature of Employee Supervisor's
IN OUT C'
ENO FORM
PDF Prescribed by P3000
EFTA00036123