Bober & Bober, P.A., Attorneys at Law
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We want to provide you with immediate feedback regarding your case.
Please complete this simple Case Evaluation so we can arrange a FREE consultation.
We look forward to discussing your legal rights.

YOUR CONTACT INFORMATION:
Name
Address
City   State   ZIP
E-mail
Telephone (H)
Telephone (W)
Cell Phone
   
THE EMPLOYER AGAINST WHICH YOU MAY HAVE A WAGE CLAIM:
Employer Name
Dates Employed From  To
Approximate Number of Employees
   
1. FOR THE PAST THREE YEARS, DID YOU WORK MORE THAN FORTY HOURS IN ONE OR MORE WORK WEEKS? ("WORK" INCLUDES ANY LABOR BENEFITING YOUR EMPLOYER, INCLUDING PREPARATORY WORK, "OFF-THE-CLOCK" WORK, BREAKS LESS THAN 20 MINUTES, AND WORK AT HOME THAT YOUR EMPLOYER SHOULD HAVE KNOWN YOU WERE DOING.)
 
2. IF YOUR ANSWER TO THE QUESTION ABOVE IS YES, PLEASE ESTIMATE HOW MANY HOURS YOU WORKED FOR WHICH YOU WERE NOT PAID TIME AND ONE HALF YOUR REGULAR RATE OF PAY (OVERTIME) FOR EVERY HOUR OVER 40.
 
3. HOW WERE YOU PAID?
 
4. DID YOUR EMPLOYER EVER GIVE YOU "COMP TIME" (I.E. TIME OFF INSTEAD OF PAYING YOU FOR HOURS WORKED OVER 40 IN ANY WORKWEEK)?
 
5. ESTIMATE YOUR REGULAR RATE OF PAY DURING ANY PERIOD IN WHICH YOU WERE NOT PAID OVERTIME? (EXAMPLE: $10.00 PER HOUR)
 
6. WHAT WAS THE TITLE OF YOUR JOB OR NAME OF YOUR POSITION?
 
7. FOR EACH JOB TITLE LISTED ABOVE, PLEASE DESCRIBE THE DUTIES OF THAT JOB.
 
8. FOR EACH JOB TITLE LISTED IN 6, ABOVE, STATE HOW MANY, IF ANY, OTHER EMPLOYEES YOU SUPERVISED DURING ANY OF THE TIME LISTED ABOVE. (IF YOU DID NOT SUPERVISE ANY OTHER EMPLOYEE, PLEASE WRITE "NONE.")
 
9. PLEASE SELECT THE STATEMENT THAT BEST DESCRIBES YOU.
 
10. WERE YOU PERMITTED TO MAKE MAJOR DECISIONS AT WORK WITHOUT CHECKING WITH ANYONE?
 
11. PLEASE DESCRIBE ANY OTHER INFORMATION WHICH YOU THINK WE SHOULD KNOW ABOUT YOUR POTENTIAL WAGE AND HOUR CLAIM.
 


Disclaimer: The recipient of this form in no way obligates Bober & Bober, P.A., Attorneys at Law, its associates or its affiliates to provide legal representation to the above-listed individual. The information being received is for informational purposes only and NO legal representation is guaranteed until a written contract is signed between Bober & Bober, P.A. and the above listed individual. Further, Bober & Bober, P.A. reserves the right to deny or refuse legal representation to the above-listed individual at its sole discretion.
 
   
     
 
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