Mand Made Pizza Form

Full Name(required)

Phone Number(required)

Email Address(required)

Which Mand Made/Domino's location(s) did you work at?(required)

Dates of Employment? (For example, June 2016-May 2017)(required)

What were you paid per mile? (For example, $0.25 per mile driven) (required)

How long was your typical shift? (required)

How many shifts did you work per week on average?(required)

In a typical week, on how many shifts did you take a 30 minute long, uninterrupted lunch break (no driving or other work)?(required)

On a typical shift, how many times did you take a 10 minute rest break (excluding your lunch break)?(required)

Did Dominos have a policy regarding taking breaks during your shifts? (required)

What was your understanding about taking breaks during your shifts?(required)

Did Dominos have a procedure for tracking breaks you took? (For example, noting breaks on time sheets)?(required)

Did you ever work off the clock? If so, please explain. (required)

Did you ever have any issues with not being paid for all of the hours you worked? If so, please explain.(required)