UFT
Nurse/Therapist Overtime Waiver Inquiry Form
This form is for inquiries regarding overtime ONLY. For inquiries regarding differentials and longevities please use the
general salary inquiry form
.
Please do not use this form for questions regarding contractual increases or payments.
Is this inquiry regarding salary differentials and/or longevities?
*
Yes
No
Name
*
First
Last
Employee ID Number
*
Title
*
Select one:
Nurse
Therapist
Nurse Supervisor
Therapist Supervisor
Phone Number
*
###
-
###
-
####
Non-DOE Email
*
Borough
*
Select one:
Bronx
Brooklyn
Manhattan
Queens
Staten Island
District
*
Select one:
BASIS HS
Bronx HS
Brooklyn HS
Manhattan HS
Queens HS
Staten Island HS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
75
79
School Site
*
Please explain your concerns.
*
Have you discussed your concerns with your payroll secretary?
*
Yes
No
What did he or she tell you?
1
/
2
Do Not Fill This Out