Unpaid Wages or Overtime Evaluation ; 1 Your Contact Information 2 Employer & Work Details 3 Statuses & Legal Actions 4 Owed Wages & Details 1. Your Contact Information Your Name* First Last Your Phone* Your Email* 2. Employer & Work Details Name of Company/Employer* Address of Work Location* Job Title* Date Started Working For Company/Employer* Date Format: MM slash DD slash YYYY Date Last Worked For Company/Employer* Date Format: MM slash DD slash YYYY Date Last Paid By Company/Employer* Date Format: MM slash DD slash YYYY Number of Days worked per week* Hours Worked Per Day* How Much Do You Get Paid? Paid By: Hour Salary Other Does Company have more than 15 employees?* Yes No Does Company have more than 50 employees?* Yes No Do you work for the government?* Yes No Are you part of a union?* Yes No Do you have an Employment Contract that Guarantees employment for 1 or more years?* Yes No Do you have contact information for Human Resource department or company management? Name of Supervisor 3. Statuses & Legal Actions Complaints Have you filed a Complaint with the Company/Employer internally?* Yes No Lawsuits Have you filed a lawsuit?* Yes No Dates & Deadlines Do you have any deadlines?* Yes No Date of Deadline Date Format: MM slash DD slash YYYY Bankruptcy Have you or will you file for Bankruptcy?* Yes No Date of Bankruptcy Date Format: MM slash DD slash YYYY Unemployment Have you filed for Unemployment Benefits?* Yes No What is the Unemployment Status? Date Date Format: MM slash DD slash YYYY Disability Benefits Have you filed for disability benefits?* Yes No Disability Date Date Format: MM slash DD slash YYYY Retirement & Pension Do you have a retirement date or pension?* Yes No Retirement/Pension Date Date Format: MM slash DD slash YYYY 4. Owed Wages & Details Having issues with: (check all that appy) I was not paid at all for at least some hours I worked: I was paid less than minimum wage I was not paid for overtime hours when I worked more than 40 hours in a week I was not given my last pay check I was required to work through breaks I was not paid at rate promised I was not paid commissions or bonus I did not receive earned sick/vacation pay I was not given all my tips Management changed my hours How much money owed? Rate of Pay or Salary? Is the company still open? Yes No What is the reason the company gave you for not paying? How much do you make per week? How much do you make every 2 weeks? How much do you make per month? How much of your wages comes from bonuses, commission or tips? Your Daily Job Duties? Do you hire or fire employees? Do you set schedules for other employees? Do you set schedules for other employees? Do you reprimand employees and enforce or set company policy? Do you open or close a store? Do you handle money for the company? Do you clock in and out of work? Do you keep records of hours worked? Your regular work schedules? How many hours worked per week? How many hours did you work but did not get paid for? How much owed for PTO, vacation pay, or commissions? How long has company been open? Does company have more than 20 employees? Does company have more than 50 employees? Have you requested the unpaid wages in writing via text message or email or letter? What county did you work in? If more than one, name of counties Do you drive a truck? Do you do deliveries? Do you work for tips? What is the least amount of tips you get in 1 week? What is your base salary or pay? What employees get to share in the tips? Dishwasher? Cook? Manager? This iframe contains the logic required to handle Ajax powered Gravity Forms.