Employer:

Job Title:


Detailed description of job responsibilities:

# of people who work for your employer:

0-25

25-100

100-500

500-1000

1000 +

# of employees w jobs similar to yours:

0-5

5-25

25-100

100-500

500-1000

1000 +


How often did you work more than 40 hrs during a week and not get paid overtime?

Weekly

Monthly

Other:

Did this happen in the last 3 years?

Yes No

Did you have any supervisory responsibility?

Yes No

If yes, describe:

Have you been paid your regular rate instead of time and a half?

Yes No

Have you worked "off the clock" b/c you were told or expected to?

Yes No

Have you not been paid overtime b/c it wasn't approved in advance?

Yes No

Have you not been paid for travel time between jobs or assignments?

Yes No

Question: