Unpaid Overtime Questionnaire

Please complete the following information and we will quickly respond.

Personal Information

1. Full Name:

2. Phone:

3. Email:

Information About Your Job 

4. Your Job Title:

5. Did you manage other employees?     Yes  No

6. Did you interview prospective employees?     Yes  No

7. Explain your job duties

Your Wage And Payment Information

8. How were you paid?

Salary  Hourly  Other

      if hourly, how much?

      if salary, how much?

      if other, how much?

9. Did you usually work more than 40 hours per week?     Yes  No

10. Average number of hours worked per week

11. Do/did you earn the same amount of pay regardless of the amount of hours worked per week?     Yes  No

12. If you worked more than 40 hours per week, did your employer regularly pay overtime wages?     Yes  No

13. If paid for overtime, your average overtime pay rate?

14. What type of records does/did your employer keep of the time you’ve spent working? (time clock, time sheets, electronic monitoring, etc.)  

15. Does/did your employer require you to stay until the job is complete regardless of the number of hours required, yet prohibit claiming overtime?      Yes  No

16. Are/were you required to arrive early without being paid for it (for example, arrive 15 minutes before the start of the work day)?     Yes  No

17. Are you aware of anyone else at your place of employment pursuing a claim against your employer for violations of overtime pay laws?     Yes  No

18. Are you aware of anyone else at your place of employment who is unlawfully being denied overtime pay?     Yes  No

Information About Your Employer

19. Name of Employer:

20. Employer City & State:

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21. Approximate Number of Employees: