TEXAS DEPARTMENT OF CRIMINAL JUSTICE
TEXAS DEPARTMENT OF CRIMINAL JUSTICERecord of Hours Worked Beyond Regular ScheduleInstructions: FLSA non-exempt employees shall use this form to record hours worked beyond their regular schedule. FLSA exempt employees shall use this form to record hours worked on regularly scheduled days off unless such hours are documented on the unit’s Duty Schedule developed and maintained by the warden or designee.Note: FLSA non-exempt employees shall physically work the number of hours in the work cycle required by PD-91 before earning overtime hours.Name (Print Last, First, Middle Initial) FORMTEXT ?????Payee ID Number FORMTEXT ?????Unit/Dept. FORMTEXT ?????FLSA Status FORMCHECKBOX Non-Exempt FORMCHECKBOX ExemptPosition Title FORMTEXT ?????Salary Group/Rate FORMTEXT ?????Work Cycle FORMCHECKBOX 7-Day FORMCHECKBOX 8-Day FORMCHECKBOX 9-DayDay Of Work CycleDateFrom:TimeTo:TimeTotal Hours/MinutesSupv.Signature1st Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????2nd Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????3rd Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????4th Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????5th Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????6th Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????7th Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????8th Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????9th Day Of Work Cycle: (check one) FORMCHECKBOX Th FORMCHECKBOX F FORMCHECKBOX Sat FORMCHECKBOX Sun FORMCHECKBOX Mon FORMCHECKBOX Tu FORMCHECKBOX W FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Justification For Time Worked: FORMTEXT ?????Employee Signature:Date: FORMTEXT ?????Work Cycle Total Overtime: FORMTEXT ?????Supervisor Signature:Date: FORMTEXT ?????If Required By Unit/Department Procedures, Warden/Department Head Signature:Date: FORMTEXT ?????Note to Employee: With few exceptions, you are entitled upon request: (1) to be informed about the information the TDCJ collects about you; and (2) under Texas Government Code §§ 552.021 and 552.023 to receive and review the collected information. Under Texas Government Code § 559.004 you are also entitled to request, in accordance with TDCJ procedures, that incorrect information the TDCJ has collected about you be corrected.Distribution:Original - Human resources representatives shall maintain original forms in a separate file by month. The files shall be sorted within the month by the beginning letter of the employees’ last name. No further alphabetization within letters A to Z is required. These records shall be maintained in compliance with the TDCJ Records Retention Schedule.Copy - Employee ................
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