BP-A0369 JUN 10 OVERTIME AUTHORIZATION U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS To MCC New York (Institution Location) (Name of Employee) You are authorized to work overtime as follows: Day of Week: Starting: 1500 5 August 2019 Monday Date: 5 August 2019 Approximate period: Purpose: project planning and administrative duties Reasons work cannot be accomplished during regular tours of duty: Shortage of administrative staff 90 minutes Warden or Authorized Supervisor In accordance with above authorization I certify I worked the following overtime: Day of Week: Starting: 1500 Monday and request: Overtime Pay Compensatory Time XXXXXXXXXX Date: Approximate period: AUX,USI 2019 90 minutes Time verified (supervisor's initial) (To be used where not authorized in advance by Warden) (Signature of Employee) Approved: Warden Instructions: (1) Where several employees authorized, use reverse side and insert in space for "name of employee' the words 'per names and periods on reverse side.' (2) "Authorized Supervisor' in accordance with written delegation of authority at institutional level per regulations. (3) To be prepared in Original only, processed in accordance with Institutional regulations and filed in payroll (older. PDF Prescribed by P3000 EFTA00036122

BP-E369 (Continued) *When employee signs he/she should indicate "P" for Overtime Pay or "C" for Com pensatory time Name of Employee Dale Time IN Time OUT P' C' Signature of Employee Supervisor's ENO FORM PDF Prescribed by P3000 EFTA00036123