EFTA00143195



BP-A0369
JUN 10


OVERTIME AUTHORIZATION

U.S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS

MCC NEW YORK

# <font color="red">(Institution Location)</font>

$$T_{O} \text{ S. CHAMBERS PP 16}$$

<table border="1"><tr><td>AUGUST 17</td><td>2019</td></tr></table>

<font color="red">(Name of Employee)</font>

You are authorized to work overtime as follows:

<table border="1"><tr><td>Day of Week:</td><td>SUNDAY</td><td>Date:</td><td>AUGUST 4</td><td>2019</td></tr></table>

Starting: 1:00 pm

Approximate period: 360 ___ 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

Rocco Lupo, BSA

92302145A1

Warden or Authorized Supervisor





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

Day of Week: SUNDAY

<table border="1"><tr><td>Date:</td><td>AUGUST 4</td><td>2017</td></tr></table>

Starting: SEE ATTACHED

Approximate period: 360 minutes

and request: Overtime Pay ___

Compensatory Time ___

S. CHAMBERS

(Signature of Employee)

Time verified ___ (supervisor's initial)

(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 '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 folder.

PDF

Prescribed by P3000