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Academy Extra Hours / Reimbursement
EMPLOYEE NAMERequired Entry
-Date Format must be e.g.: 12/28/81 or 12/28/1981
-Hour Format must be e.g.: 1:00 pm, 1:00 p.m.
DATE 1
Time of Day
From
To
HOURS FOR PAY
REASON FOR OVERTIME
DATE 2
Time of Day
From
To
HOURS FOR PAY
REASON FOR OVERTIME
DATE 3
Time of Day
From
To
HOURS FOR PAY
REASON FOR OVERTIME
DATE 4
Time of Day
From
To
HOURS FOR PAY
REASON FOR OVERTIME
DATE 5
Time of Day
From
To
HOURS FOR PAY
REASON FOR OVERTIME
Total for this Request
TOTAL HOURSRequired Entry
Submit DateRequired Entry
Reimbursement
Reimbursement Amount
Reimbursement Date
Reimbursement Reason / Location

Submit
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