Personal Information

Name

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Age
Street Address
Race
Street Address
Phone

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Religion
Cell Phone

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Disability (if any)
Email

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Employer Information

Date of Hire

Are you still Employed

No
Yes

Did you receive overtime for more than 40 hours in a work week?

No
Yes

Do you have a written employment contract?

No
Yes

Did you make any complaints of discrimination/harassment/retaliation/illegal activity?

No
Yes

Employment Law Questionnaire