Employment Status Worksheet
Exempt / Non-Exempt


Position Title & Office- Incumbent's Name

Executive Employees
An "employee employed in a bona fide executive...capacity" is exempt from overtime requirements if the employee is paid on a salary basis and meets all of the following requirements:

[_] 1. Primary duty*...management
[_] 2. Directs two or more employees
[_] 3. Hire - fire authority
[_] 4. Exercises discretion
[_] 5. Less than 20% non-exempt work
[_] 6. Salary of at least $155/week


Administrative Employees
An "employee employed in a bona fide administrative...capacity" is exempt from overtime requirements if the employee is paid on a salary basis and meets all of the following requirements:

[_] 1. Primary duty*...office/non-manual work related to management of the business
[_] 2. Exercises discretion
[_] 3. Regularly assists executive, or performs specialized work, or executes special assignments
[_] 4. Less than 20% non-exempt work
[_] 5. Salary of at least $155/week

Professional Employees
An "employee employed in a bona fide professional...capacity" is exempt from overtime requirements if the employee is paid on a salary or fee basis and meets all of the following requirements:

[_] 1. Primary duty*... work requiring advanced knowledge through prolonged course of study
[_] 2. Exercises discretion
[_] 3. Work is intellectual and varied
[_] 4. Less than 20% non-exempt work
[_] 5. Salary of at least $170/week

*Primary is defined under DOL regulations as requiring the employee to spend at least fifty percent of work time performing those duties.


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Manager's/Supervisor's Signature -------------Date ------------------HR Representative's Signature ----------------Date