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Case Evaluation Form
Case Evaluation Form
First Name *
Last Name *
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District of Columbia
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Name of company you work for:
Approximate number of employees with your job title?
Employment Start Date:
If actual date is unknown, please select the first day of the month and the year you were hired.
Employment End Date:
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.
On average, how many hours per week do you work?
How are you paid?
How much are you paid?
Are you paid time and a half if you work more than 40 hours a week?
How are you paid for hours over 40 per week?:
Not At All
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?:
Please briefly describe your primary job duties and responsibilities.:
Do you supervise two or more full-time employees?
Can you hire or fire employees?
Do you make suggestions and recommendations as to the hiring, firing, or promotion of other employees that are/were given particular weight?
Do you discipline employees?
Are you given Comp Time instead of Overtime pay?
During the last 3 years, were you paid time and a half for overtime at your prior job(s)?
Additional Information and/or your comments
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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