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Overtime And Minimum Wage Case Evaluation Request
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The More Information You Provide, The Better Initial Evaluation You Will Receive
Please understand that providing information does not mean that the FairLaw Firm has taken or will take your case. However, all information will remain confidential.
About You
Your Name
*
First
Last
Best Telephone Number To Reach You
*
Best Email Address To Reach You
*
Your Current Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
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Maine
Maryland
Massachusetts
Michigan
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Mississippi
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your Work:
Who is the employer (name of the employer)?
What Is The Address of Your Employer?
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
When Did You Start Working There?
Date Format: MM slash DD slash YYYY
How Did Your Employer Keep Time Records?
None
Clock
Sign-In Sheet
Computer
How Were You Paid?
Salary
Hourly
Check
Direct Deposit
Cash
What Was Your Job Title or What Kind Of Work Did You Do?
Did You Spend Time Supervising Other Employees?
Yes
No
Are You Still Working There?
Yes
No
If Not, Then When Was Your Last Day Of Work?
Date Format: MM slash DD slash YYYY
Why Are You Not Working There Anymore?
Minimum Wage Questions
Check all that apply
Paid Less Than $7.67/Hour in 2012
Paid Less Than $7.79 in 2013
Paid Less Than $7.93/Hour in 2014
Paid Less than $8.05/Hour in 2015 or 2016
Told that you were "exempt" from overtime
Had tip pool shared with managers/cooks/others
Not reimbursed for uniforms or other expenses
Paid as an independent contractor
Overtime Questions
Have You Worked More Than 40 Hours A Week During The Past Two (2) Years?
Yes
No
Did You Get Paid Overtime (Time And One-Half) For All Hours Worked Over 40?
Yes
No
How Many Overtime Hours Over 40 Did You Usually Work Per Week?
Check All That Apply:
You were denied overtime pay because you did not get pre-approval to work overtime.
You had a lunch break automatically deducted
You were required to work off the clock by your employer.
You were asked to work while on your lunch break, but not paid for the time.
You were paid a bonus based on productivity, profits, company performance, or some other productivity standard(s).
You reported to work early or stayed late for meetings that were not counted in the hours you worked in a day.
You had your salary or wages docked for some reason.
You worked from home (on phone calls or exchanged emails)?
Because you were paid a salary, your employer did not keep track of your hours.
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