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FLSA OT EMPLOYEE SURVEY

Fill this form out for immediate submission to our attorneys or download (PDF) or (RTF) and fax to 410-653-9061.

 

Background Questions:

First name:      Last name:

Email:

Business phone number:

Business address:


What Agency do you work for?

Job Title:

Job series:      Current grade:      Current step:

The best time and day of the week to reach you is:


Employment History

Briefly list and describe all positions, titles, grades and job series that you have held, including detailed dates you have held with the Federal government.

List your major and minor job duties (indicate which are major, which are minor) at each job you have held (and AT EACH GS LEVEL) since January 2001, estimating the amount of time you perform each duty (daily, weekly, monthly, etc.). (Minor duties may include activities not included in position description that you find yourself performing on a frequent basis.)

State if your job duties have changed since January 2001 and if so, how?

Executive Exemption

Do you supervise or lead the work of two other employees?

Yes No

If so, how many? If so, describe how you supervise the other employee(s), state their grade and job series, and estimate the amount of time you spend supervising them.

Professional Exemption

To qualify for your position, is it required, to the best of your knowledge, to have a 4-year degree or any other specialized prolonged course of institutional instruction, training, or study?

Yes No

If yes, please describe what field of knowledge and how you use that knowledge in the course of your job.

Computer Professional Exemption

Are you a systems analyst, or do you perform similar tasks?

Yes No

Are you a systems or software designer?

Yes No

Do you deal with the design or modification of machine operating systems?

Yes No

If you answered yes to any of the three previous questions, please elaborate and describe your duties.

Administrative Exemption

In your own words, what are the goals of the agency?

Is your job directly involved with accomplishing these goals?

Yes No

Do you provide expert advice to the agency’s management in specialized subject matter fields, such as that provided by a management consultant?

Yes No

If yes, please describe the nature of the advice that you provide, to whom you provide it, and your qualifications as a specialist.

Are you regularly or customarily called upon to assume facets of the overall management function, such as safety, personnel or budgeting/financial management for your office?

Yes No

If yes, please describe which facets you assume, how often you assume them, and what duties/responsibilities are associated with them.

Are you ever called upon to represent management in such business functions such as negotiating/administering contracts, determining the acceptability of goods or services, or authorizing payments for entities who are not clients, grantees or beneficiaries of the agency?

Yes No

If YES, please comment in detail about the extent of your authority to independently and on your own discretion commit management/the agency to the above mentioned agreements/goods/payments.

Are you regularly or customarily delegated substantial authority and discretion to act in place of your supervisor?

Yes No

If yes, please describe what authorities you are delegated, and any oversight procedures that exist for your use of them.

Non-Manual

Does your work customarily involve creatively selecting, adapting or innovating procedures or techniques to deal with complex situations?

Yes No

If YES, please provide examples of a situation in which you might be called upon to do this.

Do the types of decisions that you are called upon to make require high level reasoning, analysis, interpretation or judgment?

Yes No

If yes, please elaborate.

Are there standardized procedures/precedents that you rely on to make the bulk of your decisions?

Yes No

If yes, please describe in detail the extent to which these procedures, precedents, guidelines or regulations dictate your decisions, and describe under what circumstances you are allowed to deviate from them, if any.

Does the ability to effectively perform your job require substantial knowledge of a specialized subject matter field, including knowledge of techniques, principles, practices and procedures associated with that field?

Yes No

If yes, please specify the field and give examples of the associated techniques, principles, practices or procedures that you must be familiar with.

Does the ability to effectively perform your job necessitate a large amount of training or experience in a specialized subject matter field?

Yes No

If YES, please detail the amount of training in the specialized subject matter field you had upon first acquiring your job?

Discretion and Independent Judgment

Do you have the authority to independently select, adapt or innovate the techniques or procedures that you use to perform your job?

Yes No

If yes, please give an example of a typical situation in which you might be called upon to do this

Is the work that you do sufficiently complex that you are regularly called upon to exercise to select, adapt or invent the techniques or procedures that you use to perform your job?

Yes No

Do your decisions or recommendations have a significant effect on other individuals or policies?

Yes No

If yes, please describe, in general, which individuals or policies are affected, and in what way(s).

Damages

Have you come to work before the start of your shift at any time in the last three years?

Yes       No

Have you received any compensation? Check all that apply.

None       Compensatory time       Credit Hours      

Overtime Pay       Unofficial Comp time

Have you come worked through your lunch break at any time in the last three years?

Yes       No

Have you received any compensation? Check all that apply.

None       Compensatory time       Credit Hours      

Overtime Pay       Unofficial Comp time

Have you stayed at work after the end of your shift at any time in the last three years?

Yes       No

Have you received any compensation? Check all that apply.

None       Compensatory time       Credit Hours      

Overtime Pay       Unofficial Comp time

Have you come to work on weekends or federal holidays at any time in the last three years?

Yes       No

Have you received any compensation? Check all that apply.

None       Compensatory time       Credit Hours      

Overtime Pay       Unofficial Comp time

Have you taken work home and worked on it outside of the office at any time in the last three years?

Yes       No

Have you received any compensation? Check all that apply.

None       Compensatory time       Credit Hours      

Overtime Pay       Unofficial Comp time

If you earned compensatory time, were you always given the choice for paid overtime?

Yes       No

Thank you very much for taking the time to complete this questionnaire.

 
 

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