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Name *

First Name

Last Name

Email *

Phone *

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Select your area(s) of concern *

Unpaid Wages

Overtime

Minimum Wage

Work Off the Clock

Misclassified as an independent contractor

Paid Sick Time

Retaliation

Discrimination

Wrongful Termination

Non-Compete Agreement

Employment Contracts

Employment Policies

Compensation Policies

Independent Contractor Agreement

Other / Unsure

List the City and State from where you perform work for your employer:

List the name of business you’re having an employment or labor law issue with:

List your dates of employment with the business at issue:

List your job title:

Describe your job duties:

How are/were you paid by your employer?

Hourly

Salary

Bonus

Commission

Other

Describe your rates of pay and how your compensation works:

Are you paid overtime?

Yes

Not sure

List the total number of hours you work during a typical week, including actual hours worked even if some of the work is completed off the clock:

Is there any additional information you’d like to share to help us understand your employment or labor law issue?

How did you hear about us?

Thank you for your submission!

e. info@frankelsyverson.com

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2375 E Camelback Rd
Suite 600
Phoenix, AZ 85016

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9655 Granite Ridge Dr
Suite 200
San Diego, CA 92123

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