{NAME OF ORGANIZATION}

[Address of Organization]

REQUEST FOR OVERTIME OFFSET

NAME OF EMPLOYEE: ___________

DESIGNATION: _______________
UNIT: _______________
DATE FILED: _____________

Date of Overtime: _______________

Hours:
From: ______________ To: _____________

Activities Performed: ________________

______________________________________________________
______________________________________________________

To Offset on: ______________________

Hours:

From: _______________ To: ______________

Requested by: Approved by:

__________________________ __________________________
Signature over Printed Name Signature over Printed Name