Wage and Hour Settlement Approval Request Form
Submit details for review and approval of a wage and hour settlement request.
Requester Name
*
First Name
Last Name
Requester Email
*
example@example.com
Employee(s) Involved
*
Claim Context and Background
*
Settlement Summary (Key Terms and Amount)
*
Reason for Settlement
*
Proposed Settlement Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department or Manager Approval
*
Approved
Not Approved
Requires More Information
Additional Comments (Optional)
Attestation and Signature
*
Submit for Approval
Submit for Approval
Should be Empty: