2018 Government Shutdown Lawsuit

INSTRUCTIONS

To join the case, you must complete two forms: (1) The Consent to Join Collective Action and (2) the Retainer Agreement. After you electronically sign and click the “Finish” button at the bottom of the 2nd form (Retainer Agreement), you will receive a confirmation page with your “Claim Number.” Please print this page for your records. Within the next five business days, you will receive an email from info@2018governmentshutdown.com confirming the submission and attaching copies of your completed forms. If after five business days you do not receive the email, please check your spam or junk mail folder for this confirmation email. If you have any questions or problems filling out the form, please contact the law firm during normal business hours at (202-331-9260) or by email at 2018governmentshutdown@kcnlaw.com.

You will NOT be considered a plaintiff in the case until you (1) complete BOTH forms, (2) receive a claim number, and (3) receive the email confirmation.

CONSENT TO JOIN COLLECTIVE ACTION

Pursuant to Fair Labor Standards Act, 29 U.S.C. § 216(b)

1. I, the undersigned, agree to pursue my minimum wage and overtime claims arising out of work performed as an employee of the United States during the partial government shutdown that began on December 22, 2018 in the lawsuit captioned Tarovisky et al. v. United States, No. 19-cv-00004 in the United States Court of Federal Claims.

2. I was designated as an “excepted employee.” I performed work for the United States during the partial government shutdown that began on December 22, 2018, but was not paid for that work on my regularly scheduled payday(s).

3. I understand that this lawsuit is brought under the Fair Labor Standards Act (“FLSA”), as amended, 29 U.S.C. §§ 201-219. To the best of my knowledge, as of December 22, 2018, I was classified as “non-exempt” under the FLSA.

4. I consent, agree and opt in to become a plaintiff and to be bound to any judgment by the Court or any settlement of this action.

5. I designate Heidi Burakiewicz and the law firm of Kalijarvi, Chuzi, Newman & Fitch, P.C. to represent me for all purposes in this action pursuant to the terms of the Retainer Agreement that I am simultaneously signing.

6. I also designate the representative plaintiffs (Justin Tarovisky, Grayson Sharp, and Sandra Parr in addition to any other plaintiffs designated in the future as representative plaintiffs) as my agents to make decisions by majority vote on my behalf concerning the litigation, including as to any settlement agreements.

7. I agree to keep Kalijarvi, Chuzi, Newman & Fitch, P.C. informed of my up-to-date contact information including mailing address, telephone number, and e-mail address.

Signature: * Typing your name serves as your signature and that you acknowledge that: I AGREE TO THE CONTENTS OF ALL PAGES WITH AN ELECTRONIC SIGNATURE.

First Name: *

Middle Initial:

Last Name: *

Home Street Address: *

City: *

State: *

Zip: *

Federal Agency: *

Since you selected “Other” please enter the name of the Agency for which you work: *

Component:

Since you selected “Other” please enter the name of the Component for which you work

Job Location (City, State): *

Duty Assignment:

Job Title: *

Email Address: *

Do not provide your government email address. If you do not have a personal email address, please provide us with the email address of a trusted family member or friend.

Last four digits only of social security number: *

You will enter your full social security number on the retainer agreement on the next page and the last 4 digits will be entered on this line so that your full social security number is not filed in court.

Primary Phone Number: *

If you have only a home phone or cell phone, please put the same phone number in each box.

Alternate Phone Number:

* Required Field

Once you click the next button you will be taken to the second form that you must complete to join the case (the retainer agreement). You cannot hit the back button in the browser window after you hit the next button or it will delete your information and you will have to start over.