Overtime Claim Form

 

Please fill in the following information and click the submit button to complete your Overtime Claim Form:

 

First Name

 

Last Name

 

City

 

State

 

Phone

 

Email

 

Do you work more than 40 hours per week? Choose Option Yes No

 

How are you paid? Choose Option Hourly Salary Other

 

How much are you paid hourly/salary?

 

What type of industry do you work?

 

What is your job title?

 

Are you an independant contractor? Choose Option Yes No Not sure

 

Are you considered exempt from overtime? Choose Option Yes No Not sure

 

If so, why?

 

Other facts about your situation: