pp-asee.036 U.S. DEPARTMENT OF JUSTICE nov 1991 OVERTIME AUTHORIZATION FEDERAL BUREAU OF PRISONS MCC NEW YORK (Institution Location) 19 AUGUST 2019 a (Name of Employee) You are authorized to work overtime as follows: Day of Week: SATURDAY Date: 10 AUGUST 2019 Starting: 10:00 AM Approximate period: 420 10:00 AM TO 5:00PM minutes Purpose: DUE TO INSTITUTIONAL EMERGENCY Reasons work cannot be accomplished during regular tours of duty: DUE TO INSTITUTIONAL EMERGENCY Warden or Authorized Supervisor In accordance with above authorization | certify | worked the following overtime: Day of Week: SATURDAY Date: 10 AUGUST 2019 Starting: 10:00 AM Approximate period: 420 10:00 AM TO 5:00PM = minutes and request: Overtime Pay Compensatory Time (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. EFTA00142417

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BP-E369 (Continued) *When employee signs he/she should indicate “P" for Overtime Pay or "C" for Compensatory time Name of Employee END FORM Date Time Time Signature of Employee Supervisor's IN OUT fovor2010| 00mm [soon fiof | | EFTA00142418