Employee Questionnaire

Name of restaurant/bar for which you would like a case evaluation? (Please fill out a separate questionnaire for EACH establishment) Address of restaurant/bar? When did you start working there? When did you stop working there? Were there any gaps of employment of 3 weeks or more, including closures due to COVID? What was your position? (If more than one, please identify the positions and how your time was divided between the positions.) What was your hourly wage? On Average, how many days did you work per week? On Average, how many hours did you work per week? Did you receive all your paychecks? If not, how many did you not receive?

Did your employer ever adjust your hours so that you were not paid for all the time you were clocked in?

Did you ever have to work while you were not clocked in? If so, please briefly explain. If you worked off the clock, how many hours per week on average? Did you have to share your tips with other employees or the business itself? if so, please list everyone with whom you shared your tips. Did you have money deducted from your tips/wages due to customer walk-outs, broken inventory, or short drawers? If so, estimate how many times this occurred and the total amount deducted.

Please select every box for BAR-RELATED side work you were to perform

Please select every box for TABLE-RELATED side work you were to perform

Please select every box for TO-GO side work you were to perform

Please select every box for FOOD-PREPARATION side work you were to perform

Please select every box for MAINTENANCE or JANITORIAL side work you were to perform

Please list any additional side work not included on the prior lists How long did your opening side work take on average? How long did your closing side work take on average? Have you worked at any other Florida restaurant or bar in the past 5 years? Anything else we should know? How did you hear about Grossman Law, P.A.?