NEW MEXICO DEPARTMENT OF LABOR Request and Record of Overtime I. Employee Name: Employee I.D. No.

: Cost Center Name: Funding Source: Pay Period:
Maximum Hours Requested

Cash Payment * Compensatory Leave **
I agree to accept compensatory time off in lieu of cash compensation.

PLEASE CHECK ONE OF THE ABOVE

Current Hourly Rate Will overtime involve working on a holiday? If yes, specify below: No Yes

Signature of Employee

Date

II.

I certify that the nature of the unfinished work requires the services of the employee named above beyond the regular duty hours. The following justification is provided: Through: Cost Center Manager Date From: Bureau Chief Date

III. Request: Comments:

Approved:

Disapproved:

Division Director Signature IV.

Date

ACTUAL RECORD OF OVERTIME Hours to be Recorded Upon Completion Biweekly Pay Period Ending:
Worked Date Saturday Sunday Monday Tuesday Thursday Friday (1) (2) (3) (4) (6) (7)

A.M.

P.M.
From To

Pay Period Day MM / DD From To

Hours Worked

Worked Date Saturday Sunday Monday Tuesday Thursday Friday (8) (9) (10) (11) (13) (14)

A.M.

P.M.
From To

Pay Period Day MM / DD From To

Hours Worked

Wednesday (5)

/ / / / / / /
Total Hours:

Wednesday(12)

/ / / / / / /
Total Hours:

Week 1

Week 2

Grand Total Hours Worked:
Weeks 1 & 2

I certify that the overtime hours noted above were performed for the Department for the time Signature of Employee V.
Financial Management Bureau Use Only:

Date Signature of the Supervisor
Hours at Straight Time Hours at Time and One Half (1 1/2)

Date
Total Hours Paid

* = See Opposite side of form for important overtime payment guidelines. ** = Compensatory Leave is not reported to NMDOL Payroll/Benefits Office.

GUIDELINES FOR PREPARATION OF OVERTIME FORM ES-011 (Rev. 02/93) General Information 1. The overtime Form ES-011 (Rev. 01/93) must be completed in its entirety. Failure to comply with this procedure will result in its return to the applicable cost center. No information can be telephoned for the purpose of modifying the original request. Please identify the specific program / funding source that requires overtime hours. I.E. ES 205, UI 0210, BLS CES 0121 etc. 2. Overtime Payment Calculation Guideline - Overtime is paid at the time and one-half rate (1.5) ONLY WHEN the employee has worked a full 40 hours in the work week where overtime is earned. For each hour under 40 hours "worked", the employee is paid straight time for overtime hours. The following conditions shall result in a reduction of time worked against the 40 hours: annual or sick leave used, "Personal Day" leave used, Leave Without Pay (LWOP), and all forms of administrative leave, including educational leave, military leave and authorized "Physical Fitness" leave. Administrative leave taken for voting and holiday shall count as time worked for overtime calculation purposes. (This includes Jury Duty and State Fair.) 3. Approved overtime forms reflecting total hours worked must be submitted for payment with the Payroll Biweekly Time and Attendance Report to the Financial Management Bureau, Payroll/Benefits Office. 4. Overtime forms can be submitted to the Payroll/Benefits Office no earlier than the business day following the last work day where overtime is performed. 5. Approved overtime requests that will be compensated via Compensatory Leave are to be retained at the cost center and should not be forwarded to the Payroll Office. It is the responsibility of each cost center manager to maintain complete written records of all compensatory leave awards and usage by employee for audit purposes. All compensatory leave charged must be documented and awarded prior to leave taken. SECTION I - Employee Request: 1. The employee must complete ALL informational lines. 2. The employee MUST select either cash payment or compensatory time off, sign/date this section. SECTION II - Supervisor Request Approval: All requested signatures must be obtained before transmitting the request to the Division Director. SECTION III - Director's Approval: The Division Director will approve or disapprove the request and return the request to the Cost Center Manager. SECTION IV - To be completed AFTER the overtime is worked. Actual Overtime (OT) Worked and Employee Cetification: 1. The employee must enter all actual hours worked within the spaces provided. 2. Overtime forms cannot contain dates for more than one biweekly pay period. 3. Record overtime only in thirty minute (1/2 hour) increments. 4. The employee must sign and date, attesting to the actual hours of overtime worked. 5. The Supervisor must sign and date, also attesting to the actual overtime hours worked by the employee. SECTION V - Financial Management Bureau (FMB): 1. Completed overtime forms received after the last day of a pay period (a Friday) will automatically be included in the subsequent pay period. 2. The calculation of the number of hours to be compensated will be performed by the Payroll/Benefits Office. 3. Contact FMB, Payroll/Benefits Office if you have any questions regarding the completion of the form.