Pay Analysis Questionnaire

First Name*

Last Name

Phone

Email*

Position

Employer

Start Date

End Date

Still Employed

Yes
No

Work 40 or more hours in a week?

Yes
No

Are you paid overtime (1.5 Times Regular Pay) for all hours worked over 40 in a work week?

Yes
No
N/A

Is your overtime pay based on a single work week?

Yes
No
I don’t know
N/A

Payment*

Hourly
Salary
Other

Hourly Employees Should Answer the Following Questions:

For the questions below, you only need to answer those that apply to your job! Otherwise, you can just leave the answer blank. We will review your submission and follow-up with you soon.

Meal Breaks:

Were you required to take Meal Breaks?

Yes
No
I don’t know

Were your meal breaks unpaid?

Yes
No
I don’t know

Were your meal breaks 30 minutes or longer?

Yes
No
I don’t know

Were you required to perform work during your meal break or was your meal break interrupted?

Yes
No
I don’t know

Were your meal breaks automatically deducted from your pay regardless of whether you actually took a full break?

Yes
No
I don’t know

Travel Time, On-Call Time, Training, Meetings, Waiting Time:

Are you paid for travel time other than travel between your house and work?

Yes
No
I don’t know

Are you paid for training sessions?

Yes
No
I don’t know

Are you allowed to leave your place of employment while on-call?

Yes
No
I don’t know

Are you paid for work actually performed while on-call?

Yes
No
I don’t know

Are you paid for time spent waiting on the job?

Yes
No
I don’t know

Before and After your Scheduled Shift:

Are you paid for pre-shift or post-shift meetings?

Yes
No
I don’t know

Are you paid for pre-shift or post-shift activities that are for the benefit of your employer?

Yes
No
I don’t know

Do you ever work off the clock at any time?

Yes
No
I don’t know

Deductions:

Do deductions from your pay ever result in you making less than minimum wage for all hours worked?

Yes
No
I don’t know

Tipped Employees:

Are you paid a “cash” wage (not including tips) of less than $7.25?

Yes
No
I don’t know

Did your employer inform you of the amount of the cash wage you were paid?

Yes
No
I don’t know

Did your employer inform you of the additional amount claimed by the employer as a “tip credit”?

Yes
No
I don’t know

Did your employer inform you that all tips received by you are yours to keep unless you are part of a Tip Pooling arrangement?

Yes
No
I don’t know

If you are part of a Tip Pooling arrangement, do managers receive any part of the tip pool?

Yes
No
I don’t know

Are you an:*

Employee
Indepedendent Contractor

Independent Contractors Should Answer the Following Questions:

Do you have set hours or set schedule?

Yes
No
I don’t know

Are you paid by the hour, week, or month?

Yes
No
I don’t know

Does the company provide tools, materials, or other equipment?

Yes
No
I don’t know

Does the company provide you training?

Yes
No
I don’t know

Are you allowed to perform work for other companies?

Yes
No
I don’t know

Does your contract end after one job or project?

Yes
No
I don’t know

Salary Employees Should Answer the Following Questions:

Are you paid at least $455.00 per week?

Yes
No

If you miss less than a half day of work for any reason is your pay reduced by the amount of time you missed work?

Yes
No
I don’t know

Do you perform office work or non-manual work?

Yes
No
I don’t know

Do your primary job duties involve using discretion and independent judgment on significant matters?

Yes
No
I don’t know

Do you supervise 2 or more full time employees or the equivalent (1 full time, 2 part time)?

Yes
No
I don’t know

Do you have an advanced degree (masters, Ph.D., law, RN, doctor)?

Yes
No
I don’t know

Does your job use your advanced knowledge?

Yes
No
I don’t know