Polaris Law Group | Intake Form

Intake Form Please complete the below intake form for our attorney's review.

Name
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Phone
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Email
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Name of Employer
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Company Website
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Does your employer have more than 100 employees in California?
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Do you belong to the Union?
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What is your job Title
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What are your Job duties:
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Are you a current or former employee?
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What was the first date worked?
Please enter your a date.
If former, when was the last date worked?
Are you paid hourly or salary?
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If you were paid hourly, did you work any time that you were not paid for?
For example, did you have to put on any special clothing or gear prior to beginning work?
Did your employer search you after you clocked out?
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If you were searched after clocking out, where did you clock out and where were you searched?
Approximately what was the distance (how many feet) from clocking out and getting searched?
If you were paid on commission, what was the commission based on?
Did your employer pay you with a pay card?
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If so, did you sign a document authorizing the employer to pay you with a pay card?
Were there any fees incurred when using the card?
If you were paid hourly, were you provided with your meal period within the first five hours of work?
If you were paid hourly, were you allowed to leave the employer’s premises to take your rest breaks?
If terminated, what was the reason you were given?
Brief description of complaint:
Please enter a message.
Please upload 3 pay stubs from the last 12 months with the employer you're filing a claim against.
Why we need these:
- Verify your employment and dates worked
- Identify wage and hour violations (often overlooked money you're owed)
- Confirm the employer's legal name for filing purposes
Required: We cannot evaluate your case without pay stubs.
*Pay Stub (1)*
Please upload your pay stub.
*Pay Stub (2)*
Please upload your pay stub.
*Pay Stub (3)*
Please upload your pay stub.
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