LEHMAN COLLEGE 
of the City University of New York 
REQUEST FOR APPROVAL OF PAID OVERTIME 

No. of hours _________ 
Reason for overtime (Indicate emergency nature, potential losses to property, inconvenience to public, potential 
loss of revenue, legal requirements, etc.) 


. 
HOLIDAY PAY – No. of hours _____________ 
Specify Holiday _____________________ 
Name ______________________Title __________________________ SS#____________________ 
Other CUNY position, if any __________________________________________ 
Annual Salary $ ___________ Dates of Pay Period ____/____/____ through ____/____/____ 


I certify that: . the work to be performed cannot be accomplished during regular work 
Hours and that I have sufficient funds in my department budget for this payment. 
Advance approval is required for paid overtime or holiday pay. If work 
has already been performed, note highest ranking College official who 
gave approval. _________________________________ 
____/____/____ ________________________ __________ _______________________ 
Date Department Dept. Code Department Head 

_______Approved ________Denied _________Request modified as follows: 
Cost: Chargeable to: 
Rate of Pay $_________ x Hrs. worked ______ = __________ _______Tax Levy 

_______ PS Regular 
_______ Temp. Svc. 
Time & a half $_________ x Hrs. worked ______ = __________ 
Fringe Benefits (Non-tax levy only) __________ _______Non-tax Levy 
Total __________ 
Date 

 Human Resources Director Budget Approval