Overtime Questionnaire If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Date * Name First Name * Last Name * Address Address Line 1 * Address 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 State * Zip * Email * Name of employer * Length of time/dates of employment * Hourly rate of pay * Are you being paid correctly for any overtime worked? * Have you been terminated? If so, what is the date and reason for the termination? * What was your job title? * Describe your specific job duties. * What are your normal hours of work? * How much time do you spend preparing to do your work before you begin to get paid? What do you have to do to prepare to do your work - equipment check out and other activities? When do you clock in at work? How many breaks do you get during your workday? Are they paid or unpaid? What do you have to prepare to leave at the end of the shift - equipment check-in, etc.? Are these activities at the end of the shift performed before or after you clock out at the end of your shift? Are you paid bonuses in connection with your work? If so, please describe what bonuses you are paid and when your are paid the bonus. Please give a summary of your work history for the past 10 years - include the name of the employer, dates of employment, reason for leaving and pay. * Please give a summary of any criminal charges you have had over the last 10 years. * Have you or your spouse filed bankruptcy? If so, when and where? * Don’t work for free another day. Contact us and we’ll help you receive the fair compensation that you deserve.