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Address
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Email
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Job Title
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Date of Hire
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How You Were Paid
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Hourly
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How Much You Made Per Week
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Duties and Responsibilities
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claims and issues
Please Check All Box That Are Applicable
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I did not get paid for all of my time
My employer did not keep track of my time accurately
My paystubs are inaccurate or lack information
I did not receive uninterrupted meal and/or rest breaks
Other
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If NO Longer Employed (please select one)
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I Quit or Voluntarily Resigned
I was Terminated
It's a Long Story
None of the Above
Last Day of Work (if applicable)
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Employer information
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Address
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State
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Phone Number
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Number of Employees in California
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Please estimate the total number of individuals employed by your Employer
Number of Affected Employees in California
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Please use your best to estimate the total number of employees that were affected by the same issue(s).
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