FLSA QUESTIONNAIRE
CITY OF NEW YORK

This questionnaire is designed to help us evaluate possible claims that the City of New York is not complying with the Fair Labor Standards Act. If you have any questions about the questionnaire, please call Will Aitchison at (503) 282-6160 or by e-mail at will@aitchisonvick.com.

BACKGROUND INFORMATION

ITEMS IN BOLD ARE REQUIRED.

First Name: Initial: Last Name:

Address:

City: State: Zip:

Home Telephone:   Work Telephone:

Personal E-Mail Address:

Password:
You are required to enter a password. This is used if you want changes made to your questionnaire.

Badge Number:

Job Title or Classification:

Your Current Assignment:

All of the information from this point forward in the questionnaire refers to events occurring at any point over the last three years.

CALCULATION OF OVERTIME RATE

Have you received shift differential? Yes     No    Don't Know

What other forms of premium pay, specialty pay, incentive or hazardous duty pay have you received over the last three years?

If you have received premium, specialty, incentive, hazardous duty, or shift differential pay, was it included in the calculation of your overtime rate?
Yes    No    Don't Know

HOURS OF WORK ISSUES

Do you work the 5-2, 5-3 tour? Yes    No

If your answer is "no," please describe your work shift, including the length of the shift, the number of days worked in a row, and the number of days off :

Have you worked any of the following forms of uncompensated time?

Off-duty tasks/care/maintenance
      Motorcycle
      Canine
      Mounted Patrol
      Take-home car
        maintenance/cleaning

Pre-shift preparation

Pre-shift patrol car assignment

Pre/post-shift load/unload patrol car

Post-shift report writing

Work as Field Training Officer

Other (please specify):

If you checked any of the boxes above, please provide details as to what type of work was involved, when it was performed, and what supervisors knew of the work:

STANDBY AND ON-CALL ISSUES

If you were ever placed on standby status, please describe the circumstances, including the restrictions on your activities while on standby and the pay, if any, your received while on standby:

TRAINING ISSUES

Have you attended any training which resulted in you working longer than a 40-hour week without you receiving any additional compensation? Include, if applicable, such training as Academy training, SWAT, annual inservice training, and the like. If so, please describe the circumstances and frequency this has occurred:

Have you served as an instructor or presenter in any training which resulted in you working longer than a 40-hour week without you receiving any additional compensation? Include any off-duty preparation time or development of lesson plans and/or instructor work in recruit academy, if applicable. If so, please describe the circumstances and frequency this has occurred:

MEDICAL/PHYSICAL EXAMINATIONS

During the last three years, have you been subject to any employer-required medical or psychological evaluations by the City where you were not paid for the time spent during the evaluation? If you were required to take vacation or sick leave to account for the time spent in the evaluation, you should answer this question as if you were not paid for the time. Include any annual physicals for which you were not paid, or any compulsory activities such as AA meetings. Please provide details:

TRAVEL TIME ISSUES

Have you been required to travel on City business without being paid for all travel time? If so, please provide the details, provide any documents detailing dates of travel, time spent traveling and corresponding paychecks showing payment for travel hours showing pay period when travel was taken: Include such travel as work on extraditions, investigation, training, and the like:

COMPENSATORY TIME OFF ISSUES

If you have received compensatory time off in lieu of cash payment for overtime, please check which (if any) of the following box(es) apply to you:

I have been denied the use of compensatory time off when the City could have filled in for me with another employee, even where the other employee would have been paid at the overtime rate.

Some or all of the compensatory time off was accrued at the straight time rate rather than the overtime rate.

I have forfeited compensatory time off without compensation.

I have had more than 480 hours of compensatory time off on the books at any one time.

I have had compensatory time off deducted because of the employer's travel time policies.

If you have ever been forced to accept compensatory time off in lieu of cash payment for overtime when you reached a certain amount of overtime worked (for example, 35 hours in a month, or 105 hours in a quarter), or if you feel you have been pressured or coerced to accept compensatory time off, please provide the details.

OTHER ISSUES

Have you been expected to work "voluntary" time or any hours for which you were not compensated? If so, please provide details as to what type of work was involved, when it was performed, and what supervisors knew of the work:

Is there any other way in which you feel you have not been fairly compensated for overtime hours worked? If so, please provide details.

Please carefully review your answers before submitting the form.