Have you ever experienced work conditions that you believe were unhealthy, caused you undue stress or made you sick? Please share it with us.
We will never share your personal information. If you are interested in being interviewed (see below), we will ask you to sign a release form granting your approval to use your story.

We will only send information related to "Working on Empty" as you consent to per the settings below.

Last Name, First Name (e.g.: Doe, Jane) *
Your answer
Email *
Your answer
State (within the U.S.) *
Your answer
Zipcode *
Your answer
Write a paragraph about your (true-to-life) work-related experiences which document unhealthy work conditions, such as: job strain (high demands w/low control), high stress workplaces, excessive overtime, unsupportive managers, unfair wage disputes, lack of benefits (no paid sick leave or vacation time), job insecurity, freelance or temporary contracts, unsafe workplaces, etc. If someone you know has relevant experiences, please share our website and ask them to fill out the "Share Your Story" form themselves. *
Your answer
Would you be willing to be interviewed further via email or over the phone? *
Required
Would you be willing to be interviewed on camera for our multi-media documentary? *
Required
Send me e-mail updates about your project. *
Required
Are you interested in participating further in our multi-media documentary by following us on social media and/or donating? *
Required
Visit WorkingonEmpty.org for more info.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms