Unpaid Wages or Overtime Evaluation ; 1 Your Contact Information2 Employer & Work Details3 Statuses & Legal Actions4 Owed Wages & Details 1. Your Contact InformationYour Name* First Last Your Phone*Your Email* 2. Employer & Work DetailsName 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:HourSalaryOtherDoes Company have more than 15 employees?*YesNoDoes Company have more than 50 employees?*YesNoDo you work for the government?*YesNoAre you part of a union?*YesNoDo you have an Employment Contract that Guarantees employment for 1 or more years?*YesNoDo you have contact information for Human Resource department or company management?Name of Supervisor 3. Statuses & Legal ActionsComplaintsHave you filed a Complaint with the Company/Employer internally?*YesNoLawsuitsHave you filed a lawsuit?*YesNoDates & DeadlinesDo you have any deadlines?*YesNoDate of Deadline Date Format: MM slash DD slash YYYY BankruptcyHave you or will you file for Bankruptcy?*YesNoDate of Bankruptcy Date Format: MM slash DD slash YYYY UnemploymentHave you filed for Unemployment Benefits?*YesNoWhat is the Unemployment Status?Date Date Format: MM slash DD slash YYYY Disability BenefitsHave you filed for disability benefits?*YesNoDisability Date Date Format: MM slash DD slash YYYY Retirement & PensionDo you have a retirement date or pension?*YesNoRetirement/Pension Date Date Format: MM slash DD slash YYYY 4. Owed Wages & DetailsHaving 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?YesNoWhat 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 countiesDo 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.