EFTA00143192



BP-A0369
JUN 10


OVERTIME AUTHORIZATION

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

# MCC NEW YORK

# (Institution Location)

To D. CAGNARD PP16

<table><tr><td>AUGUST 18</td><td>2019</td></tr></table>

[Name of Employee]

You are authorized to work overtime as follows:

<table border="1"><tr><td>Day of Week:</td><td>SEE ATTACHED</td><td>Date:</td><td>SEE ATTACHED</td><td>2019</td></tr></table>

Starting: VARIES

Approximate period: **SEE ATTACHED** minutes

Purpose: TO WORK VARIOUS SHIFTS

Reasons work cannot be accomplished during regular tours of duty: NO OTHER STAFF AVAILABLE

ONE COOK SUPERVISOR ON AL AND ONE COOK SUPERVISOR ON SL NO GATE PASS ORDERLIES

92302145A1

Warden or Authorized Supervisor





In accordance with above authorization I certify I worked the following overtime:

Day of Week: ___ SEE ATTACHED

Date: SEE ATTACHED 2017

Starting: SEE ATTACHED

Approximate period: SEE ATTACHED minutes

and request: Overtime Pay ___

Compensatory Time ___

D. CAGNARD

Time verified ___ (supervisor's initial)

(Signature of Employee)

(To be used where not authorized in advance by Warden)

Approved:





Warden

Instructions:

(1) Where several employees authorized, use reverse side and insert in space for "name of employee" the words 'nor 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 folder.

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Prescribed by P3000

EFTA00143193

BP-E369 (Continued)

*When employee signs he/she should indicate "P" for Overtime Pay or "C" for Com pensatory time

<table><thead><tr><th>Name of Employee</th><th>Date</th><th>Time IN</th><th>Time OUT</th><th>P* C*</th><th>Signature of Employee</th><th>Supervisor&#39;s</th></tr></thead><tbody><tr><td></td><td></td><td></td><td></td><td>VA</td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td>SE</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/05/2019</td><td>2:00 pm</td><td>5:00 pm</td><td>P</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/09/2019</td><td>2:00 pm</td><td>3:00 pm</td><td>P</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/12/2019</td><td>2:00 pm</td><td>5:00 pm</td><td>P</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/13/2019</td><td>2:00 pm</td><td>3:00 pm</td><td>P</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/14/2019</td><td>2:00 pm</td><td>6:00 pm</td><td>P</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/15/2019</td><td>2:00 pm</td><td>3:30 pm</td><td>P</td><td></td><td></td></tr><tr><td>D. CAGNARD</td><td>08/17/2019</td><td>8:00 am</td><td>4:00 pm</td><td>P</td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>





END FORM

PDF

Prescribed by P3000

EFTA00143194

<table><thead><tr><th>EMPLOYEE: Chambers, Steve</th><th>PP: 16/2019</th><th>SHIFT: DW</th><th>DAYS OFF: Sat/Sun.</th></tr></thead></table>

<table><thead><tr><th>Week 1</th><th>0500 1300</th><th>0500 1300</th><th>0500 1300</th><th>0500 1300</th><th>0600 1300</th><th></th><th></th><th></th><th></th><th></th><th>0500 1300</th><th>0500 1300</th><th>0500 1300</th><th>0500 1300</th><th></th><th></th><th>Week 2</th></tr></thead><tbody><tr><td></td><td>S</td><td>M</td><td>T</td><td>W</td><td>TH</td><td>FR</td><td>S</td><td>1:00 pm</td><td>TYPE OF DUTY</td><td>CODE</td><td>S</td><td>M</td><td>T</td><td>W</td><td>TH</td><td>FR</td><td>S</td><td></td></tr><tr><td>DATE</td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td></td><td></td><td></td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td></td></tr><tr><td></td><td>4</td><td>5</td><td>6</td><td>7</td><td>8</td><td>9</td><td>10</td><td></td><td></td><td></td><td>11</td><td>12</td><td>13</td><td>14</td><td>15</td><td>16</td><td>17</td><td></td></tr><tr><td></td><td></td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td></td><td>01/1</td><td>REGULAR / SH1</td><td>01/1</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>01/2</td><td>REGULAR / SH2</td><td>01/2</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>01/3</td><td>REGULAR / SH3</td><td>01/3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>8</td><td></td><td></td><td></td><td></td><td></td><td></td><td>04/1</td><td>SUNDAY / SH1</td><td>04/1</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>04/2</td><td>SUNDAY / SH2</td><td>04/2</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>04/3</td><td>SUNDAY / SH3</td><td>04/3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>61</td><td>ANNUAL LV</td><td>61</td><td>8</td><td>8</td><td>8</td><td>8</td><td>8</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>62</td><td>SICK LV</td><td>62</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>62/62</td><td>SICK LEAVE - FFLA</td><td>62/62</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>61/66</td><td>Time Off Award</td><td>61/66</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>64</td><td>COMP USED</td><td>64</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>66</td><td>HOLIDAY OFF</td><td>66</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>6</td><td></td><td></td><td></td><td></td><td></td><td></td><td>21</td><td>OVERTIME</td><td>21</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>32</td><td>COMP EARNED</td><td>32</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>66/1</td><td>HOLIDAY OFF/SH1</td><td>66/1</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>66/2</td><td>HOLIDAY OFF/SH2</td><td>66/2</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>66/3</td><td>HOLIDAY OFF/SH3</td><td>66/3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>31/1</td><td>HOLIDAY WRK/SH1</td><td>31/1</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>31/2</td><td>HOLIDAY WRK/SH2</td><td>31/2</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>31/3</td><td>HOLIDAYWRK/SH3</td><td>31/3</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>67</td><td>COP - INJURY LV</td><td>67</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>63</td><td>RESTORED LV</td><td>63</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>65</td><td>MILITARY LV</td><td>65</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>61/TC</td><td>VLTP DONATION</td><td>61/TC</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>TRAINING</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>AUGMENTATION</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>46</td><td>TOTAL HOURS</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>40</td></tr></tbody></table>

TIMEKEEPER___EMPLOYEE___SUPERVISOR___