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Case Evaluation – Part 2
The more information you provide, the quicker we can assess your claim. Please answer the questions below. Our review is free and confidential. Thank you.
Case Evaluation Form - Confidential Review
Step 1 of 6
16%
On average, how many hours per week do you work?
How much are you paid?
How are you paid?
Hourly
Salary
Day Rate
Commission
Other
dollars per
Hour
Day
Week
Month
Year
Piece
Are you paid time and a half if you work more than 40 hours a week?
Yes
No
How are you paid for hours over 40 per week?:
Straight Time
Not At All
Comp Time
Other
If you were paid for your overtime, are your bonuses, shift differential and/or other incentive pay included when your employer calculates your overtime pay rate?:
Yes
No
Don't Know
Job Title:
Approximate number of employees with your job title?
Please briefly describe your primary job duties and responsibilities:
Do you supervise two or more full-time employees?
Yes
No
Do you discipline employees?
Yes
No
Can you hire or fire employees?
Yes
No
Do you make suggestions and recommendations as to the hiring, firing, or promotion of other employees that are/were given particular weight?
Yes
No
Additional Information and/or your comments
Employment Start Date:
Date Format: MM slash DD slash YYYY
If actual date is unknown, please select the first day of the month and the year you were hired.
Employment End Date:
Date Format: MM slash DD slash YYYY
Leave blank if you are still employed with the same company. If actual date is unknown, please select the first day of the correct month and year.
Name of company you work for:
During the last 3 years, were you paid time and a half for overtime at your prior job(s)?
Yes
No
Full Name
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Submitting this form does not establish an attorney client relationship and does not obligate this firm to represent you. We may or may not be able to undertake representation on your behalf, but we will gladly review the information you provide and respond to you. The information contained on this site is not and is not intended to be legal advice. You should always consult an attorney for individualized advice about your particular situation. I have read and understand the above.
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