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Back to Forms for 'Compensation & Benefits'.





To: ______________________ (employee)



The company attempts to provide employees with an alleviation of all duties and responsibilities during the regular meal period.  Unfortunately, due to the nature of your position, the company is unable to relieve you of all duties and responsibilities during your regular meal period. 


In consideration for this inconvenience, we will pay you at your regular rate of pay for the duration of your on-the-job meal period.


Should you choose to voluntarily agree to this arrangement, please sign below.



Manager __________________________                           Date _____________




Employee Signature _________________________              Date _____________

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