Your most recent job title with above employer:
What was your most recent rate of pay with this employer?
Please Explain
What was the reason your employer gave you for the termination?
Explain
Explain
Explain
What were your usual working hours? (Start and end time, for example, 8:00 am. – 6:00 pm). Please state the hours you actually usually worked, not just what you were scheduled for.
What were your rates of pay, and when? (Estimates are okay.)
What other compensation were you paid? (Circle all that apply): Bonuses, Commissions, Tips, Other (specify):
What job titles did you hold with your employer, and when?
For each job title you listed above, please generally describe the duties of that job:
If at any time you had any supervisory responsibility with your employer, describe, and when:
If you worked more than 8 hours per day and/or 40 hours per week, why was this required?
How did your employer know?
How many days per week, on average, did you work more than 8 hours per day?
How many weeks per year, on average, did you work more than 40 hours per week?
What conversations, if any, did you have with your employer regarding working hours?
What documents, if any, exist that can help us prove your hours worked?
How many of your co-workers were treated the same way as you?
If your co-workers were treated the same as you, please provide their names, addresses, and telephone numbers, if known:
For how long each day?
After how many hours of work?
State the type and amount of the work-related expenses you were not reimbursed for:
How many days per year of paid vacation did your employer provide?
Why not?
On what basis (i.e., race, age [over 40], national origin, sexual orientation, religion, disability, marital status, pregnancy, gender, sexual harassment, etc.)?
Why do you believe your treatment at work was motivated by discrimination or harassment?
Briefly describe the basis (younger, not disabled, not homosexual, different religion, etc.) and the different treatment:
Describe and include witness contact information, including name, address if known, telephone and/or email if known, their position at the company, and whether or not they are currently part of your employer's management:
List the managers / owners responsible for your wages, hours, and working conditions.
What efforts have you made to find new employment?
Who have you been treated or examined by for the emotional distress, and when?
