Let’s Get Started!Long-Form Intake Your Name * Your Phone Number * Your Email * Are you owed money? * Yes No Maybe Approximately how much are you owed? If you had to guess, how much would you say you're owed? I am a: * Current Employee Former Employee Employer Independent Contractor Job Applicant Other I am a: What is your job title? What was your job title? How are you paid? (Check all that apply) Salary Hourly Commissions Bonuses Piece Rate Other What other forms of payment do you receive? How were you paid? (Check all that apply) Salary Hourly Commissions Bonuses Piece Rate Other What other forms of payment did you receive? About how much are you paid each year? $25,000 or less $25,001–$50,000 $50,001–$75,000 $75,001–$100,000 More than $100,000What was the approximate rate of pay for the job you applied for? $25,000 or less $25,001–$50,000 $50,001–$75,000 $75,001–$100,000 More than $100,000About how much were you paid each year? $25,000 or less $25,001–$50,000 $50,001–$75,000 $75,001–$100,000 More than $100,000 What is the name of the employer? How many people work for the employer? 1–4 5–24 25–50 51–100 101 or MoreIs the employer a government agency? Yes No I don't knowAre you paid overtime if you work more than 8 hours in a day or 40 hours in a week? Yes No I don't work that many hoursWere you paid overtime if you work more than 8 hours in a day or 40 hours in a week? Yes No I don't work that many hoursAre you provided all meal periods and rest breaks required by law? Yes No I'm not sureWere you provided all meal periods and rest breaks required by law? Yes No I'm not sureAre you part of a union? Yes No I don't knowWere you part of a union? Yes No I don't know Please describe your dispute. If you are human, leave this field blank. SubmitWork Lawyers PCJanuary 3, 2021January 3, 2021