Please provide your name:
Please provide your postal address:
Street
City
State
Zip Code
CA
Please provide your email address:
Please provide your telephone number:
Please tell us what time of day you may be reached by phone:
Are you submitting information about your current employer, or a former employer?
If you are submitting information about your former employer, how long ago did you last work there?
About
years and
months ago .
What is your job title? (For example, "cashier", "assistant manager", "welder")
No matter what your job title was, or is, please describe the type of work you actually perform. (For example: "Unload trucks.") The more detail you can provide, the better.
OPTIONAL QUESTION: What is the name of the employer about which you are submitting information?
What business is that employer in? (For example, "Manufactures tools", or "retail sales".)
Where (i.e., street and city) did you work (or do you work) for the employer about which you are submitting information?
Street
City
State
Zip Code
CA
While you were employed there, did you ever work more than eight (8) hours in a day, or more than forty (40) hours in a week?
If so, were you paid overtime compensation when you worked more than eight (8) hours in a day, or more than forty (40) hours in a week?
If you were not paid overtime, did the employer give you any reason?
Were you (or are you) an hourly employee, or a salaried employee?
Did the employer ever keep you "on stand-by", or "on call"? (This is where an employee is required to be ready to report to work on short notice.)
If the employer ever kept you “on stand-by”, or “on call”, were you paid for any time your “stand-by”, or “on call”, status prevented you from doing other things?
While you were employed there, did you ever work “off the clock”? If so, please explain the circumstances which led to this.
Do you have any reason to believe or suspect that time cards might have been altered, either physically or electronically, so as to inaccurately under-state the number of hours worked?
When you have completed the above, please just click on “submit” below: