SOP 104.32-att-1: Certification for Payment of Call Back Pay

SOP 104.32
Attachment 1

7/30/19

|FACILITY/OFFICE:|EMPLOYEE ID NUMBER:|
|---|---|
|EMPLOYEE NAME:

|TITLE:|
|PAYGRADE:

|HOURLY RATE:
|
|REGULAR SCHEDULED WORK HOURS:

|REGULAR SCHEDULED WORK HOURS:

|
|CALL BACK DATES/TIME:|CALL BACK DATES/TIME:|
|DATE/DAY|TIME|
|||
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|||
|||
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|FOR DEPARTMENT OF HUMAN RESOURCES OFFICE USE ONLY|FOR DEPARTMENT OF HUMAN RESOURCES OFFICE USE ONLY|
|TOTAL # OF CALL BACKS:

@ $____________________ PER HOUR|TOTAL # OF CALL BACKS:

@ $____________________ PER HOUR|

I CERTIFY THAT THE ABOVE NAMED EMPLOYEE OF THE GEORGIA DEPARTMENT OF CORRECTIONS MEETS
ALL CRITERIA OUTLINED IN SOP 104.32, AND THEREFORE, IS ELIGIBLE TO BE PAID CALL BACK PAY.

|DATE:|Appointing Authority/Designee:|
|---|---|
|DATE:|Local Human Resources Representative:

|

Retention Schedule: Upon completion, this form shall be permanently retained in official personnel file and retained for six
(6) full months, following payment of Call Back Pay, in the local personnel file.