MARCUS A. EAST, M.D.
JOHN G. DODD, D.O.
RYAN W. LAPOUR, M.D.
ADAM T. SHUPE, O.D.
MCEC OVERTIME AUTHORIZATION FORM
Todays Date:
Employee Name:
Department:
Project or Purpose of Overtime Work:
Hours requested to be worked in excess of 40 per week:
Date and time of hours requested to be worked (Date / AM / PM / Short Lunch)
Ongoing or Estimated End Date to Complete Project:
Request is authorized in full
Request is not authorized
Request is granted, subject to modification as follows:
Supervisor, Manager or Clinic Administrator Authorizing Overtime
