Overtime Claim Form

The following details are from Geni. If any of them are wrong, please contact graduateenquiries@leadershipacademy.nhs.uk to get them corrected before trying again.
First Name
Last Name
Assignment Number
Email Address
Specialism
Intake
Authorised Signatory First Name
Authorised Signatory Last Name
Authorised Signatory Email Address

Claim Details Optional

Date	Start Time	End Time	Hours	Actions
				Edit Delete
There are no Entries.

Maximum number of entries reached.

Did you work 37.5 standard hours in the week of this claim?
Yes
No
Please explain why you did not work 37.5 standard hours in the week of this claim

Is there anything exceptional about this claim that may need it to be handled differently from a standard overtime claim?
Yes
No
What is exceptional about this claim?

Total Hours
Please double-check the details of your claim and, if they are correct, check the confirmation box below and then click the Submit button to send in your claim.

Once you submit this form your claim will be sent to your authorised signatory for approval.

If any of your details or your authorised signatory's details are wrong then please close this form and correct them in Geni before trying again.

If any of the time information is wrong then please go back (by clicking on the Previous button) to correct them.

Providing incorrect information on this form will likely result in your claim being delayed.
Confirmation

I confirm that the details I have provided on this form are true and accurate

Step 1 of 6