Siegel Law Group

INFO SHEET - Wyoming Case


Fair Labor Standards Act of 1938, 29 U.S.C. 216(b)

I hereby consent to be a party plaintiff seeking unpaid wages and overtime pay in the case in which this consent is filed. By joining this lawsuit, I designate the named plaintiff(s) in which this consent is filed, and his/her attorneys (and other persons those individuals designate as necessary) as my representatives to make all decisions on my behalf, to the extent permitted by law, concerning the method and manner of conducting the case including settlement, the entering of an agreement with Plaintiff’s counsel regarding payment of attorneys’ fees and court costs, and all other matters pertaining to this lawsuit. I further acknowledge that I intend for this consent to be filed in order to recover my overtime wages against my current/former employer whether in the above-captioned action or in any subsequent action that may be filed on my behalf for such recovery, and this consent may be used in this case or in any subsequent case as necessary. For purposes of pursuing my unpaid wage and overtime claims I choose to be represented by Lee & Braziel, LLP, the Siegel Law Group PLLC, and other attorneys with whom they may associate.

Signed Date:

This information will not be made part of any public record and is necessary for your attorney’s files for litigation and possible settlement purposes in regards to your Wyoming Casing claims.

Your Name:

Locations Worked At (city, state, call center):   

Job Title(s):  

Start Date:   

End Date:   

Estimated Yearly Pay:   

Hourly Compensation:   

Estimated Hours Per Week:   

Wet Pay Payment (if applicable): 

Stand By Hourly Rate (if applicable): 

Hourly Rate After 12 Hours in Field (if applicable):   

Pay Per Foot of Pipe: 

Your Address:   

City, State, & Zip Code:   


Best Time to Call:   

Email Address:   

Signature Certificate
Document name: INFO SHEET - Wyoming Case
Unique Document ID: 1f656b4e6445857b5f1bdee76649dd391272bbcc
Timestamp Audit
2016-05-30 11:25:48 PSTINFO SHEET - Wyoming Case Uploaded by Jack Siegel - IP