SECTION 3. WORK HOURS AND WAGES (continued)
DO EMPLOYEES WORK DIFFERENT SCHEDULES OR IRREGULAR HOURS SO YOU CANNOT PROVIDE A STANDARD WORK SCHEDULE? YES NO
IF “YES,” BRIEFLY DESCRIBE THE DIFFERENT SCHEDULES OR IRREGULAR WORK HOURS AS BEST AS YOU CAN: ____________________________
____________________________________________________________________________________________________________________
WHEN IS THE NORMAL OR STANDARD SCHEDULED MEAL PERIOD FOR EMPLOYEES?
START TIME: _________ AM PM
END TIME: _________ AM PM
THERE IS NO STANDARD SCHEDULED MEAL PERIOD
MINUTES
HOURS
WHAT IS THE AVERAGE LENGTH OF TIME FOR AN EMPLOYEE’S MEAL PERIOD? ________
WHO SET THE WORK SCHEDULE? (FULL NAME AND JOB TITLE/POSITION): ____________________________________________________________
WHAT DAY IS PAY DAY?
DAILY
WEEKLY ON __________________________
BI-WEEKLY ON
__________________________
(Once every two weeks)
MONTHLY ON ________________________
SEMI-MONTHLY ON
____________________________
(Twice a month)
WHO PAYS EMPLOYEES? (FULL NAME AND JOB TITLE/POSITION): ___________________________________________________________________
ARE EMPLOYEES PAID BY THE HOUR? YES NO
IF “YES,” HOW MUCH? $ __________ PER HOUR
VARIES (EXPLAIN):_____________________________________________________________________________________________________
ARE EMPLOYEES PAID A FIXED AMOUNT OF WAGES (OR SALARY), REGARDLESS OF THE NUMBER OF HOURS WORKED? YES NO
IF “YES,” HOW MUCH? $ ___________ PER DAY
PER WEEK
EVERY 2 WEEKS
SEMI-MONTHLY
MONTHLY
VARIES (EXPLAIN):_____________________________________________________________________________________________________
ARE EMPLOYEES PAID BY PIECE RATE? YES NO
IF “YES,” HOW MUCH? $ ________ PER (Describe Unit) ___________________________
PIECE RATES VARY (EXPLAIN): ____________________________________________________________________________________________
HOW ARE EMPLOYEES PAID? CHECK
CASH
BOTH CHECK & CASH
OTHER METHOD (EXPLAIN): ________________________________________________
METHOD OF PAYMENT VARIES PER EMPLOYEE OR JOB POSITION (EXPLAIN): _______________________________
______________________________________________________________________________________________
IF EMPLOYEES ARE PAID IN CASH, DOES THE EMPLOYER KEEP CASH PAYMENT RECORDS OR LOGS? YES NO
DON’T KNOW
DOES THE EMPLOYER KEEP TIME RECORDS OF HOURS WORKED BY EMPLOYEES? YES NO
DON’T KNOW
WHAT LANGUAGES ARE SPOKEN BY EMPLOYEES? ENGLISH SPANISH MIXTEC TRIQUE CANTONESE MANDARIN KOREAN
VIETNAMESE TAGALOG CAMBODIAN HMONG THAI PUNJABI
HINDI
RUSSIAN
OTHER: _____________
SECTION 4. SUSPECTED VIOLATIONS OF EMPLOYER
The boxes below describe conduct by an employer that violates the law. Please put a check mark in the box(es) if the employer
engages in, or any employee or employees have experienced, any of the following violations:
NO WORKERS’ COMPENSATION INSURANCE
CHILD LABOR VIOLATIONS:
No valid work permit(s)
No valid entertainment work permit(s)
Minor(s) work excessive or prohibited hours
Minor(s) work in hazardous conditions
Estimated number of minors affected: _________
MINIMUM WAGE VIOLATIONS:
OVERTIME VIOLATIONS:
Paid below minimum wage
Not paid daily overtime for hours worked over 8 hours per
Not paid at all for overtime hours worked
day (or 10 hours per day for farmworkers)
Not paid for all hours worked, including unpaid travel time and
Not paid weekly overtime for hours worked over 40 hours
try-out time
per week
Paycheck issued with insufficient funds
Not paid double time for hours worked over 12 hours per
Asked employee to pay back wages paid
day
No split shift premium pay
Not paid overtime for working on the 7th consecutive
workday in a workweek
Estimated number of employees affected: _________
Estimated number of employees affected: _________
BOFE 1 (Rev. 11/2012)
Page 2 of 3