FLSA Exemption Test Form

FLSA Exemption Test Form

EXECUTIVE

An employee with the primary duty of managing the enterprise or a customarily recognized department or division thereof may be entitled to the Executive Exemption. Those that qualify are generally responsible for the success or failure of business operations under their management. /
Job Class: Click here to enter text. / Class Code: Click here to enter text. /
Working Title: Click here to enter text. / Agency: Choose an item. /
1. /

Does the incumbent regularly and customarily supervise 3 or more full time employees (or equivalent FTEs) within his or her department or subdivision?

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Supervise 3 or more: FLSA standard is 2 employees; Standard for State of Minnesota as an employer (per Bureau of Mediation Services) is 3.
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
If you answered yes above, does the incumbent….
a.  Interview, select, and train employees?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
b.  Coach employees in proper job performance techniques and procedures?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
c.  Direct the work of employees?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
d.  Set and adjust hours of work?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
e.  Recommend promotions or other changes in status?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
f.  Discipline employees under their supervision, as necessary?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
g.  Apportion work among employees?
Check One:
YES ☐ NO ☐ / Notes: Click here to enter text.
2. /

Does the incumbent share supervision of employees with anyone else?

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Check One:
YES ☐ NO ☐ / Notes: Click here to enter text. /
3. /

Does the incumbent have hire/fire authority? In no, do they make recommendations on hire/fire?

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Check One:
YES ☐ NO ☐ / Notes: Click here to enter text. /
4. /

Does the incumbent supervise employees in all areas of their duties, or do they supervise employees as a “project lead”?

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Check One:
YES ☐ NO ☐ / Notes: Click here to enter text. /
5. /

How important are supervision duties in comparison to other duties?

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Select one: Choose an item. /
6. /

What percent of working time is spent supervising and executing leadership duties and responsibilities?

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Select one: Choose an item. /
7. /

What percent of time is spent performing duties similar to those they supervise?

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Select one: Choose an item. /
8. /

For Mixed Classes Only: What criteria does the agency relay upon when making the FLSA designation decision at the position level?

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Response: Click here to enter text. /
/ Other Considerations: Click here to enter text. /
Final Determination: Does this position meet the Executive Exemption Duties test? /
Check One: YES ☐ NO ☐ / Notes: Click here to enter text. /