Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Department / Role:
*
Please Select
Sales
Marketing
Planning
Scheduling
Gear
Data
Production
Total Additional Hours Requested:
*
How many hours have you worked this week so far (at time of request)?
*
What did you accomplish during that time?
*
Why is additional time needed? What will be done with the overtime?
*
Can this work be shifted to regular hours next week?
*
Yes
No
Unapproved Overtime May Not Be Paid
*
I understand that unapproved overtime may not be paid, and repeated violations may result in disciplinary action.
Effective Use of Regular Hours
*
I confirm that I have used my regular scheduled hours effectively this week before requesting additional time.
Approval Based on Business Needs
*
I understand that this request will be evaluated based on urgency, workload, and budget, and may be denied even if the task feels important.
Frequent Requests May Trigger Review
*
I understand that frequent overtime requests may lead to a workload or time management review.
Honesty & Integrity in Submissions
*
I agree to provide accurate and honest information on this form and understand that misuse of time or misreporting may affect my role or status within the company.
Overtime Is Not Guaranteed
*
I understand that overtime must be approved in advance and is not guaranteed, even if requested.
Submit
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