Pope, Berger, & Williams, LLP

Employment / Labor Law Form (Employee's Version)
( *denotes required fields )

Date:

*Name:

*Address:

*City:

*State:

*Zip Code:

*Telephone:

*Your Email Address:

Is this email address provided
by your employer:

*Name of Employer:

Address of employer

Number of Employees:

Your Position:

Briefly describe your typical duties:

Were/Are you paid a salary or an hourly rate?

Salary or Hourly Rate:

Length of employment:

If you quit or were terminated, date of quit or termination:

Did/Does your employer keep track of your hours worked?
(i.e., time clock, time cards)

If salaried, do you believe you are/were properly classified as an exempt employee?

If not, why?

If salaried, did/do you spend the majority of your time with managerial and administrative duties?

If salaried, did/do you earn at least $2,340.00 per month?

Were/Are you classified as an independent contractor?

Do you believe you should be/should have been classified as an employee?

If so, why?

Did/Do you normally work over 40 hours per week?

If yes, how many hours per week did/do you work on average?

Did/Do you get paid time and one-half for your overtime?

Were/Are you paid at least minimum wage ($6.75/hr. since 1/1/02) for all hours worked?

Were/Are you given paid 10 minute rest breaks for every 4 hours worked?

Were/Are you given unpaid meal breaks of at least 30 minutes for every 5 hours worked?

Are there other current or former employees that are in the same situation?

Did/Do you have an
Employment Contract:

Did you sign an arbitration agreement with your employer?

If your complaint is about unpaid wages, what kind of wages do you believe are due?

If you are not now employed, under what circumstances did you leave?

Is your leaving your employment what is motivating you to contact an attorney?

If you were terminated or laid off, what was the reason your employer gave you (even if you do not believe it)?

If you do not believe your employer's reason, what do you think the real reason was?

If there is a reason other than or in addition to your termination, what is the situation that is leading you to contact an attorney?

If your complaint is about sexual harassment, describe the nature of the harassment

What is the harasser's position?
(i.e., supervisor, co-worker)

What do you think is causing/caused the sexual harassment?

Did you complain about the sexual harassment?

If yes, to whom did you complain?
(Identify by position, i.e., my supervisor)

If your complaint is about discrimination,
what type of discrimination?
(check all that apply):

Race	Sex
Disability	Nationality
Age	Other
Religion

If age discrimination, how old are you?

If your complaint is about sexual harassment or discrimination, have you filed a claim with the DFEH and/or EEOC?

What do you want Pope, Berger & Williams, LLP to do for you?

Please provide any additional information you believe would be important for the attorneys to know:

This questionnaire is intended to help Pope, Berger & Williams, LLP perform a preliminary evaluation of your case. The sending or receipt of information does not create an attorney-client relationship between you and Pope, Berger & Williams, LLP. While Pope, Berger & Williams, LLP will keep any information provided to us confidential, due to the nature of internet communication, communication with Pope, Berger & Williams, LLP through this web site may not be considered privileged or confidential. Please see our disclaimer for greater detail.

Pope, Berger & Williams, LLP does not represent union or government employees.