Human resources
Overtime request template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
Fill in this template- Written for US law, with your state left to fill in
- Fill the blanks in your browser
- Print, or save as PDF or Word
- No account needed to start
Preview — US standard
Overtime Request
To: Manager Name, Manager Title
From: Requester Name, Requester Title, Department
Date: Request Date
I am requesting approval for overtime work as follows:
| Employee | Date | From | To | Hours |
| --- | --- | --- | --- | --- |
| First Employee Name | First Overtime Date | First Start Time | First End Time | First Hours |
| Second Employee Name | Second Overtime Date | Second Start Time | Second End Time | Second Hours |
Total overtime hours: Total Overtime Hours
Estimated cost: $Estimated Overtime Cost
Reason
Reason, such as a deadline, staff shortage or urgent work
Work to Be Done
Work to Be Done During Overtime
Non-exempt employees will be paid at one and a half times their regular rate for hours over 40 in a workweek, and as state law otherwise requires (for example, daily overtime in some states). All hours actually worked will be recorded and paid, whether or not approved in advance.
Requester Signature
Requester Printed Name
Decision
Decision: Approved, Approved with Changes or Not Approved
Approved hours: Approved Hours
Approved by: Approver Name and Signature Date: Decision Date