NEW MEXICO DEPARTMENT OF LABOR

Request and Record of Overtime

I. Employee Name:
Cash Payment *
Employee I.D. No.:
Cost Center Name: Compensatory Leave **
Funding Source: I agree to accept compensatory time off in
Pay Period: lieu of cash compensation.
Maximum Hours Requested PLEASE CHECK ONE OF THE ABOVE
Current Hourly Rate
Will overtime involve working on a holiday?
Yes No If yes, specify below: Signature of Employee Date

II. I certify that the nature of the unfinished work requires the services of the employee named
above beyond the regular duty hours. The following justification is provided:

Through: From:
Cost Center Manager Date Bureau Chief Date
III. Request: Approved: Disapproved:
Comments:

Division Director Signature Date

IV. ACTUAL RECORD OF OVERTIME
Hours to be Recorded Upon Completion
Biweekly Pay Period Ending:
Worked Worked
Date A.M. P.M. Hours Date A.M. P.M. Hours
Pay Period Day MM / DD From To From To Worked Pay Period Day MM / DD From To From To Worked
Saturday (1) / Saturday (8) /
Sunday (2) / Sunday (9) /
Monday (3) / Monday (10) /
Tuesday (4) / Tuesday (11) /
Wednesday (5) / Wednesday(12) /
Thursday (6) / Thursday (13) /
Friday (7) / Friday (14) /
Total Hours: Total Hours:
Week 1 Week 2
Grand Total Hours Worked:
Weeks 1 & 2
I certify that the overtime hours noted above were performed for the Department for the time

Signature of Employee Date Signature of the Supervisor Date

Hours at Hours at Time and One
V. Financial Management Bureau Use Only: Straight Time Half (1 1/2) Total Hours Paid

* = See Opposite side of form for important overtime payment guidelines.

** = Compensatory Leave is not reported to NMDOL Payroll/Benefits Office.
 GUIDELINES FOR PREPARATION OF
OVERTIME FORM ES-011 (Rev. 02/93)

General Information

1. The overtime Form ES-011 (Rev. 01/93) must be completed in its entirety. Failure to comply with this procedure
will result in its return to the applicable cost center. No information can be telephoned for the purpose of
modifying the original request. Please identify the specific program / funding source that requires overtime hours.
I.E. ES 205, UI 0210, BLS CES 0121 etc.
2. Overtime Payment Calculation Guideline - Overtime is paid at the time and one-half rate (1.5) ONLY WHEN the
employee has worked a full 40 hours in the work week where overtime is earned. For each hour under 40 hours
"worked", the employee is paid straight time for overtime hours. The following conditions shall result in a
reduction of time worked against the 40 hours: annual or sick leave used, "Personal Day" leave used, Leave
Without Pay (LWOP), and all forms of administrative leave, including educational leave, military leave and
authorized "Physical Fitness" leave. Administrative leave taken for voting and holiday shall count as time worked
for overtime calculation purposes. (This includes Jury Duty and State Fair.)
3. Approved overtime forms reflecting total hours worked must be submitted for payment with the Payroll Biweekly
Time and Attendance Report to the Financial Management Bureau, Payroll/Benefits Office.
4. Overtime forms can be submitted to the Payroll/Benefits Office no earlier than the business day following the last
work day where overtime is performed.
5. Approved overtime requests that will be compensated via Compensatory Leave are to be retained at the cost
center and should not be forwarded to the Payroll Office. It is the responsibility of each cost center manager to
maintain complete written records of all compensatory leave awards and usage by employee for audit purposes.
All compensatory leave charged must be documented and awarded prior to leave taken.

SECTION I - Employee Request:

1. The employee must complete ALL informational lines.

2. The employee MUST select either cash payment or compensatory time off, sign/date this section.

SECTION II - Supervisor Request Approval:

All requested signatures must be obtained before transmitting the request to the Division Director.

SECTION III - Director's Approval:

The Division Director will approve or disapprove the request and return the request to the Cost Center Manager.

SECTION IV - To be completed AFTER the overtime is worked.

Actual Overtime (OT) Worked and Employee Cetification:

1. The employee must enter all actual hours worked within the spaces provided.
2. Overtime forms cannot contain dates for more than one biweekly pay period.
3. Record overtime only in thirty minute (1/2 hour) increments.
4. The employee must sign and date, attesting to the actual hours of overtime worked.
5. The Supervisor must sign and date, also attesting to the actual overtime hours worked by the employee.

SECTION V - Financial Management Bureau (FMB):

1. Completed overtime forms received after the last day of a pay period (a Friday) will automatically be included in
the subsequent pay period.
2. The calculation of the number of hours to be compensated will be performed by the Payroll/Benefits Office.
3. Contact FMB, Payroll/Benefits Office if you have any questions regarding the completion of the form.