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Georgia State University
Overtime Authorization Form
Today’s Date (MM/DD/YY): _______________
Employee Requesting Overtime: _____________________________________
(Print Name)
Employee Title: ___________________ Department: ___________________
Purpose of Overtime Work:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Hours requested to be worked in excess of 40 per week: __________
Date and time of hours requested to be worked: _______________________
_______________________
Request is authorized in full
Request is not authorized
Request is granted, subject to modification as follows:
_______________________________________________________________________
Supervisor Authorizing Overtime:
______________________________________
(Print Name and Title)
______________________________________ ____________
(Signature) (Date)