ep-a0360 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 | certify | worked the following overtime: Day of Week: Monday Date: 5 August , 2019 Starting: 1500 Approximate period: 90 minutes and request: Overtime Pay XXXXXAKKKK Compensatory Time | Pere (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 folder. PDF Prescribed by P3000 EFTA00036122

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BP-E369 (Continued) *When employee signs he/she should indicate "P" for Overtime Pay or "C" for Com pensatory time Name of Employee ee Signature of Employee Supervisor's IN OUT END FORM PDF Prescribed by P3000 EFTA00036123