George Bean Law Client Inquiry
Client Information Form
Your Name: *
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Email Address: *
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Phone: *
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Name of Employer *
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Your Position *
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Approximate Number of Employees:
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Are you still employed with employer? *
Date of Hire: *
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How were you paid? *
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How often did you get paid? *
What was your rate of pay?
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Did you ever work more than 8 hours per day or 40 hours per week?
Did your employer pay you overtime wages when you worked over 8 hours per day or 40 per week?
Did you ever work off the clock?
What pay issues do you think you have?
Do you believe you were discriminated against?
On what basis were you discriminated against?
Describe the discrimination and how it related to your membership in the protected category
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Were you retaliated against for making a complaint?
Describe the complaint you made and to whom you made it
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Are there any documents or witnesses that support your claim(s)?
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Is there anything else you would like to tell us?
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How did you hear about George Bean Law?
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