|                                                                         |                                                                   | MCC New York                                                                      |                         |         |
|-------------------------------------------------------------------------|-------------------------------------------------------------------|-----------------------------------------------------------------------------------|-------------------------|---------|
|                                                                         |                                                                   | (Institution Location)                                                            |                         |         |
|                                                                         |                                                                   |                                                                                   | 5 August                | 2019    |
| To<br>(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: |                         |         |
|                                                                         | Monday                                                            | Date:                                                                             | AUX,USI                 | 2019    |
|                                                                         | 1500                                                              | Approximate period:                                                               | 90                      | minutes |
|                                                                         |                                                                   |                                                                                   |                         |         |
|                                                                         | XXXXXXXXXX                                                        |                                                                                   |                         |         |
|                                                                         | Compensatory Time                                                 |                                                                                   |                         |         |
|                                                                         |                                                                   |                                                                                   | (Signature of Employee) |         |
|                                                                         |                                                                   | (supervisor's initial)                                                            |                         |         |
|                                                                         |                                                                   |                                                                                   |                         |         |
|                                                                         |                                                                   |                                                                                   |                         |         |
|                                                                         | (To be used where not authorized                                  | Approved:                                                                         |                         |         |
| in advance by Warden)                                                   |                                                                   |                                                                                   |                         |         |
| Day of Week:<br>Starting:<br>and request: Overtime Pay<br>Time verified |                                                                   | Warden                                                                            |                         |         |
|                                                                         |                                                                   |                                                                                   |                         |         |
| Instructions:                                                           |                                                                   |                                                                                   |                         |         |

(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.

## 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<br>IN | Time<br>OUT | P'<br>C' | Signature of Employee | Supervisor's |
|------------------|------|------------|-------------|----------|-----------------------|--------------|
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ENO FORM