Quick Case Evaluation

Name: Email:

Address: City: State: Zip:

Home Phone: Work Phone:

The employer against whom you have a claim:

Dates Employed:
-

Estimated Number of Employees:

9. Please choose the statement which best describes your job during the period when you were not paid overtime:

Work Place:
---Always worked at my employer's facilityMost of the time outside the officeI could work wherever I wantedOther (please explain)
Other (please explain):

Work Supervision:
---I was rarely supervisedI was closely supervised part of the timeI was closely supervised all of the timeOther (please explain)
Other (please explain):

Decision Making:
---I could make major decisions without checkingSometimes I could make major decisions without checkingAny major decision had to be cleared with my supervisorsOther (please explain)
Other (please explain):

Work Hours:
---I had set work hours which were monitoredWorks hours were set by me to get the job doneOther (please explain)
Other (please explain):

Work Assignments:
---I decided what to do, then did itI was provided with a rough assignment and it was up to meI was provided with details but it was up to meI was provided with details and followed established proceduresI did was I was instructed to doOther (please explain)
Other (please explain):

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